H. Y. Zhou1,2, J. C. He1,2, C. R. McHenry2,3 1University Hospitals Case Medical Center,Surgery,Cleveland, OH, USA 2Case Western Reserve University School Of Medicine,Cleveland, OH, USA 3MetroHealth Medical Center,Surgery,Cleveland, OH, USA
Introduction:
Preservation of the parathyroid glands either in situ or by autotransplantation is important in preventing permanent hypoparathyroidism. The parathyroid glands are 5mm or less in size, often intracapsular or intrathyroidal and obscured by central compartment lymph nodes, making preservation a challenge. The purpose of this study was to determine the incidence of inadvertent parathyroidectomy (IP) during thyroidectomy, its risk factors and whether it contributes to the development of hypoparathyroidism.
Methods:
A retrospective review of all thyroid operations performed by a single surgeon from January 1, 2010 through July 31, 2014 were reviewed to determine the rate of IP and permanent hypoparathyroidism. Patient medical records were assessed for demographics, extent of thyroidectomy, central compartment lymph node dissection, thyroid gland weight, retrosternal goiter, parathyroid autotransplantation, reoperation, pathology, postoperative calcium levels and number of parathyroid glands inadvertently removed.
Results:
Three hundred eighty-six patients underwent thyroidectomy, including 243 total and 17 completion thyroidectomies and 126 lobectomies. Mean age was 51.8 ± 14.1 years and 327 (85%) patients were female. There were 25 (6%) reoperations, 40 (10%) patients had central compartment lymph node dissection and 128 (33%) underwent parathyroid gland autotransplantation. IP occurred in 78 (20%) patients, 16 of whom had intrathyroidal glands. Permanent hypoparathyroidism occurred in 7 (2.7%) of 260 patients following total or completion thyroidectomy, 4 (5%) with IP compared to 3 (1%) without IP (p = 0.033). Logistic regression analysis revealed that female gender (odds ratio = 2.768, p = 0.040), central compartment lymph node dissection (odds ratio = 9.584, p = 0.001), and thyroid gland weight (odds ratio = 0.994, p = 0.022) were independent factors associated with IP.
Conclusion:
IP, which occurred in 20% of patients undergoing thyroidectomy, is a remediable factor that was associated with a higher rate of hypoparathyroidism. Central compartment lymph node dissection is an independent risk factor for IP.