The Preservation and Autotransplantation of the Parathyroid Glands in Total Thyroidectomy in Patients With Thyroid Cancer—A Strategy for Avoiding Permanent Hypoparathyroidism

Hypoparathyroidism is a complication that occurs after total thyroidectomy (TT) in patients with thyroid cancer. We tried to determine a strategy for avoiding permanent hypoparathyroidism. A total of 42 patients underwent TT for thyroid cancer between April 2009 and March 2014. One or more parathyroid glands (PGs) could be macroscopically preserved in all of the patients. First, we evaluated the association between the number of PGs that were macroscopically preserved and the postoperative course in 28 patients without autotransplantation. The number of preserved PGs was not associated with postoperative tetany or the serum levels of calcium or phosphorous on postoperative day 1, or the proportion of patients who needed to take calcium supplements or a vitamin D analog. However, only the patients with a single preserved PG required calcium supplementation for longer than 1 year (33.3%, P < 0.05). Next, we compared the clinical course with PG autotransplantation in 16 patients in whom a single PG was preserved. Although the result was not statistically significant, only the patients without autotransplantation required calcium supplementation for longer than 1 year. To avoid permanent hypoparathyroidism after TT, it should be essential to preserve at least 2 PGs or to preserve 1 PG and perform autotransplantation.

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Time to parathyroid function recovery in patients with protracted hypoparathyroidism after total thyroidectomy

Acta Endocrinologica ◽

10.1530/eje-17-0589 ◽

2018 ◽

Vol 178 (1) ◽

pp. 103-111 ◽

Cited By ~ 11

Author(s):

Inés Villarroya-Marquina ◽

Juan Sancho ◽

Leyre Lorente-Poch ◽

Lander Gallego-Otaegui ◽

Antonio Sitges-Serra

Keyword(s):

Thyroid Cancer ◽

Total Thyroidectomy ◽

Serum Calcium ◽

Calcium Concentration ◽

Common Adverse Effect ◽

Parathyroid Glands ◽

Permanent Hypoparathyroidism ◽

Serum Calcium Concentration ◽

Parathyroid Function

Objective Hypocalcaemia is the most common adverse effect after total thyroidectomy. It recovers in about two-thirds of the patients within the first postoperative month. Little is known, however, about recovery of the parathyroid function (RPF) after this time period. The aim of the present study was to investigate the time to RPF in patients with protracted (>1 month) hypoparathyroidism after total thyroidectomy. Design Cohort prospective observational study. Methods Adult patients undergoing total thyroidectomy for goitre or thyroid cancer. Cases with protracted hypoparathyroidism were studied for RPF during the following months. Time to RPF and variables associated with RPF or permanent hypoparathyroidism were recorded. Results Out of 854 patients undergoing total thyroidectomy, 142 developed protracted hypoparathyroidism. Of these, 36 (4.2% of the entire cohort) developed permanent hypoparathyroidism and 106 recovered: 73 before 6 months, 21 within 6–12 months and 12 after 1 year follow-up. Variables significantly associated with RPF were the number of parathyroid glands remaining in situ (not autografted nor inadvertently resected) and a serum calcium concentration >2.25 mmol/L at one postoperative month. Late RPF (>6 months) was associated with surgery for thyroid cancer. RPF was still possible after one year in patients with four parathyroid glands preserved in situ and serum calcium concentration at one month >2.25 mmol/L. Conclusions Permanent hypoparathyroidism should not be diagnosed in patients requiring replacement therapy for more than six months, especially if the four parathyroid glands were preserved.

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Risk factors of permanent hypoparathyroidism after total thyroidectomy and central neck dissection for papillary thyroid cancer: a prospective study

Endokrynologia Polska ◽

10.5603/ep.a2020.0006 ◽

2020 ◽

Vol 71 (2) ◽

pp. 126-133

Author(s):

Paulina Godlewska ◽

Małgorzata Benke ◽

Elżbieta Stachlewska-Nasfeter ◽

Jacek Gałczyński ◽

Bartosz Puła ◽

...

Keyword(s):

Risk Factors ◽

Thyroid Cancer ◽

Prospective Study ◽

Total Thyroidectomy ◽

Neck Dissection ◽

Central Neck Dissection ◽

Central Neck ◽

Permanent Hypoparathyroidism ◽

Papillary Thyroid ◽

A Prospective Study

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Association between number of parathyroid glands identified during total thyroidectomy and functional parathyroid preservation

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02287-6 ◽

2021 ◽

Author(s):

Fiona Riordan ◽

Matthew S. Murphy ◽

Linda Feeley ◽

Patrick Sheahan

Keyword(s):

Vitamin D ◽

Multivariate Analysis ◽

Total Thyroidectomy ◽

Parathyroid Glands ◽

Graves Disease ◽

Permanent Hypoparathyroidism ◽

Academic Teaching ◽

Postoperative Hypoparathyroidism ◽

Academic Teaching Hospital ◽

Systematic Identification

Abstract Purpose Systematic identification of all 4 parathyroid glands has been recommended during total thyroidectomy (TT); however, it is unclear whether this strategy necessarily translates into optimized functional parathyroid preservation. We wished to investigate the association between number of parathyroids identified intraoperatively during TT, and incidence of incidental parathyroidectomy, and postoperative hypoparathyroidism. Methods Retrospective review of prospectively maintained database of 511 consecutive patients undergoing TT at an academic teaching hospital. The association between number of parathyroid glands identified intraoperatively and incidence of biochemical hypocalcaemia (defined as any calcium < 2 mmol/L n first 48 h after surgery), symptomatic hypocalcaemia; permanent hypoparathyroidism (defined as any hypocalcaemia or need for calcium or vitamin D > 6 months after surgery), and incidental parathyroidectomy, was investigated. The association between number of parathyroid glands visualized and postoperative parathyroid hormone (PTH) levels was investigated in a subset of 454 patients. Results Patients in whom a greater number of parathyroids had been identified had a significantly higher incidence of biochemical and symptomatic hypocalcaemia, and significantly lower postoperative PTH levels, than patients with fewer glands identified. There were no significant differences in incidence of permanent hypoparathyroidism or incidental parathyroidectomy. On multivariate analysis, malignancy, Graves disease, and identification of 3–4 parathyroids were independent predictors of biochemical hypocalcaemia. For symptomatic hypocalcaemia, identification of 2–4 parathyroids, and identification of 3–4 parathyroids, were significant. Conclusions Systematic identification of as many parathyroid glands as possible during TT is not necessary for functional parathyroid preservation.

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Effect of autotransplantation of a parathyroid gland on hypoparathyroidism after total thyroidectomy

Endocrine Connections ◽

10.1530/ec-17-0313 ◽

2018 ◽

Vol 7 (2) ◽

pp. 286-294 ◽

Cited By ~ 4

Author(s):

Anping Su ◽

Yanping Gong ◽

Wenshuang Wu ◽

Rixiang Gong ◽

Zhihui Li ◽

...

Keyword(s):

Total Thyroidectomy ◽

Neck Dissection ◽

Parathyroid Gland ◽

Central Neck Dissection ◽

Parathyroid Glands ◽

Central Neck ◽

Permanent Hypoparathyroidism ◽

Papillary Thyroid ◽

Transient Hypoparathyroidism

Background The effect of parathyroid autotransplantation on hypoparathyroidism is not fully understood. The purpose of the study was to determine the effect of autotransplantation of a parathyroid gland on the incidence of hypoparathyroidism and recovery of parathyroid function at 6 months after total thyroidectomy with central neck dissection for papillary thyroid carcinoma. Methods All patients with autotransplantation of a parathyroid gland (no inadvertent parathyroidectomy) (group A), in situ preservation of all parathyroid glands (no autotransplantation and inadvertent parathyroidectomy) (group B) or inadvertent removal of a parathyroid gland (no autotransplantation) (group C) who underwent first-time total thyroidectomy with central neck dissection for papillary thyroid carcinoma between January 2013 and June 2016 were included retrospectively. Results Of the 702 patients, 383, 297 and 22 were respectively included in the groups A, B and C. The overall rates of transient and permanent hypoparathyroidism were 37.6% and 1.0%. The incidence of transient hypoparathyroidism was 43.9, 29.0 and 45.5% (A vs B, P = 0.000; A vs C, P = 1.000), and the incidence of permanent hypoparathyroidism was 1.0, 0.7 and 4.5% (P > 0.05). The recovery rates of serum parathyroid hormone levels were 71.4, 72.2 and 66.0% at 6-month follow-up (P > 0.05). Conclusion Autotransplantation of a parathyroid gland does not affect the incidence of permanent hypoparathyroidism, but increases the risk of transient hypoparathyroidism when the rest of parathyroid glands are preserved in situ. At least 2 parathyroid glands should be preserved during total thyroidectomy with central neck dissection to prevent permanent hypoparathyroidism.

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Serum levels of intact parathyroid hormone on the first day after total thyroidectomy as predictor of permanent hypoparathyroidism

Endocrinología Diabetes y Nutrición (English ed ) ◽

10.1016/j.endien.2018.08.006 ◽

2019 ◽

Vol 66 (3) ◽

pp. 195-201

Author(s):

Pablo Calvo Espino ◽

José Ángel Rivera Bautista ◽

Mariano Artés Caselles ◽

Javier Serrano González ◽

Arturo García Pavía ◽

...

Keyword(s):

Parathyroid Hormone ◽

Total Thyroidectomy ◽

Serum Levels ◽

Intact Parathyroid Hormone ◽

Permanent Hypoparathyroidism

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Metastasis of Thyroid Cancer to the Sternum after Total Thyroidectomy and Laryngectomy

Case Reports in Surgery ◽

10.1155/2013/346246 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

Hajime Ishinaga ◽

Tomotaka Miyamura ◽

Hironori Tenpaku ◽

Kazuhiko Takeuchi

Keyword(s):

Thyroid Cancer ◽

Total Thyroidectomy ◽

Differentiated Thyroid Cancer ◽

Postoperative Course ◽

Bony Metastasis ◽

Sternal Tumor ◽

Thyroid Papillary ◽

New Material ◽

Sternal Reconstruction

Metastasis of thyroid cancer to the sternum is rare. Ablation is the therapy of choice for patients with metastasizing differentiated thyroid cancer, while surgical resection is an option for those with resectable bony metastasis. This report describes a case of a 65-year-old woman with a sternal tumor. The patient was treated by partial sternal resection and sternal reconstruction with new material polypropylene/expanded polytetrafluoroethylene (ePTFE) composite. The postoperative course was uneventful, and she was free of recurrence after 1 year of follow-up. We conclude that surgery should be used to manage solid bony metastasis from thyroid papillary carcinoma. Further more, a polypropylene/ePTFE composite may be useful for sternal reconstruction after thoracotomy.

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Indocyanine Green Angiography for Parathyroid Gland Evaluation during Transoral Endoscopic Thyroidectomy

Journal of Personalized Medicine ◽

10.3390/jpm11090843 ◽

2021 ◽

Vol 11 (9) ◽

pp. 843

Author(s):

Tsung-Jung Liang ◽

Kuo-Chiang Wang ◽

Nai-Yu Wang ◽

I-Shu Chen ◽

Shiuh-Inn Liu

Keyword(s):

Indocyanine Green ◽

Total Thyroidectomy ◽

Parathyroid Gland ◽

Calcium Supplementation ◽

Intraoperative Imaging ◽

Endoscopic Thyroidectomy ◽

Central Neck Dissection ◽

Parathyroid Glands ◽

Functional Evaluation ◽

Icg Angiography

Indocyanine green (ICG) angiography, a real-time intraoperative imaging technique, is associated with better parathyroid identification and functional evaluation during open thyroidectomy. However, the benefits of ICG fluorescence imaging application in transoral endoscopic thyroidectomy are not well-documented. Consecutive patients who underwent transoral endoscopic thyroidectomy were retrospectively reviewed. Parathyroid glands were assessed with visual inspection followed by ICG angiography. The fluorescence intensity of all parathyroid glands was recorded. In total, 158 parathyroid glands from 60 patients (41 underwent lobectomy and 19 underwent total thyroidectomy) were eligible for evaluation. A total of 135 parathyroid glands (85.4%) were identified, including nine glands (5.7%) that were solely localized because of ICG angiography. Incidental parathyroidectomy occurred in 12 patients with predominant inferior gland (83.3%) and associated with central neck dissection (66.7%). Among patients receiving total thyroidectomy, patients who retained at least one well-perfused parathyroid gland had higher parathyroid hormone (PTH) level and were less likely to develop hypoparathyroidism on postoperative day one than those without any well-perfused ICG-enhanced parathyroid gland (p = 0.038). In addition, the duration of calcium supplementation to maintain normocalcemia was also shorter. ICG angiography is a feasible adjunct procedure for parathyroid identification and postoperative functional prediction in transoral endoscopic thyroidectomy.

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Duration of Parathyroid Function Recovery in Patients With Protracted Hypoparathyroidism After Total Thyroidectomy for Papillary Thyroid Carcinoma

Frontiers in Endocrinology ◽

10.3389/fendo.2021.665190 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yuxuan Qiu ◽

Zhichao Xing ◽

Qiao Xiang ◽

Qianru Yang ◽

Anping Su ◽

...

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Total Thyroidectomy ◽

Parathyroid Glands ◽

Permanent Hypoparathyroidism ◽

Papillary Thyroid ◽

Parathyroid Function ◽

Function Recovery ◽

One Year

PurposeThe aim of the present study is to investigate the time to recovery of parathyroid function in patients with protracted hypoparathyroidism at 1 month after total thyroidectomy of papillary thyroid carcinoma.Materials and MethodsAdult patients who underwent total thyroidectomy for papillary thyroid cancer were included. Cases of long-term hypoparathyroidism were studied for recovery of parathyroid function during the follow-up. The duration of recovery and associated variables were recorded.ResultsOut of the 964 patients, 128 (13.28%) developed protracted hypoparathyroidism and of these, 23 (2.39%) developed permanent hypoparathyroidism and 105 (10.89%) recovered: 86 (8.92%) before 6 months, 11 (1.14%) within 6 and 12 months and 8 (0.83%) after 1 year follow-up. Variables significantly associated with the time to parathyroid function recovery were number of autotransplanted parathyroid glands (HR, 1.399; 95% CI, 1.060 – 1.846; P = 0.018), serum calcium concentration >2.07 mmol/L (Hazard ratio [HR], 1.628; 95% confidence interval [CI], 1.009 – 2.628; P = 0.046) and PTH level > 1.2 pmol/L (HR, 1.702; 95% CI, 1.083 – 2.628; P = 0.021) at 1 month postoperatively.ConclusionPermanent hypoparathyroidism should not be diagnosed easily by time, since up to one-fifth of the patients will experience recovery after a period of 6 months and a few patients even beyond one year. The number of autotransplanted parathyroid glands is positively associated with the time to parathyroid function recovery.

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Abstract #1086: Patient Experience with Severe Low Energy Following Total Thyroidectomy for Papillary Thyroid Cancer

Endocrine Practice ◽

10.1016/s1530-891x(20)44216-8 ◽

2017 ◽

Vol 23 ◽

pp. 258

Author(s):

Elizabeth Wendt ◽

Maria Bates ◽

Reese Randle ◽

Jason Orne ◽

Cameron Macdonald ◽

...

Keyword(s):

Thyroid Cancer ◽

Total Thyroidectomy ◽

Papillary Thyroid Cancer ◽

Patient Experience ◽

Low Energy ◽

Papillary Thyroid

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Radiation Sickness after Therapeutic Administration of 806 mCi of 131I for Thyroid Cancer

Nuklearmedizin ◽

10.1055/s-0037-1621327 ◽

1967 ◽

Vol 06 (02) ◽

pp. 170-183

Author(s):

K. Šilink ◽

J. Němec ◽

J. Kubal ◽

S. Röhling ◽

S. Vohnout

Keyword(s):

Bone Marrow ◽

Thyroid Cancer ◽

Radiation Injury ◽

Clinical Course ◽

External Irradiation ◽

Bone Marrow Depression ◽

Erythroid Hyperplasia ◽

Cytological Features ◽

Haematological Changes ◽

Therapeutic Administration

SummaryThe clinical course and the haematologic events in a patient suffering from metastatic thyroid cancer after administration of 806 mCi of 131I are described. A serious bone marrow depression developed and was treated successfully. The haematological changes during the early and late phases of the radiation injury were studied in detail and compared with those after external irradiation. The haematological events after internal irradiation with 131I are characterised by initial neutrophilic leukocytosis, protracted lymphopenia, slowly developing anaemia reaching lowest values about 3 months after administration, erythroid hyperplasia in the bone marrow after recovery from bone marrow depression and prominent cytological features of the bone marrow, especially pronounced erythropoietic polyploidy.

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