Cargando…
Association between number of parathyroid glands identified during total thyroidectomy and functional parathyroid preservation
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 para...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8847165/ https://www.ncbi.nlm.nih.gov/pubmed/34406491 http://dx.doi.org/10.1007/s00423-021-02287-6 |
_version_ | 1784651992619024384 |
---|---|
author | Riordan, Fiona Murphy, Matthew S. Feeley, Linda Sheahan, Patrick |
author_facet | Riordan, Fiona Murphy, Matthew S. Feeley, Linda Sheahan, Patrick |
author_sort | Riordan, Fiona |
collection | PubMed |
description | 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00423-021-02287-6. |
format | Online Article Text |
id | pubmed-8847165 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-88471652022-02-23 Association between number of parathyroid glands identified during total thyroidectomy and functional parathyroid preservation Riordan, Fiona Murphy, Matthew S. Feeley, Linda Sheahan, Patrick Langenbecks Arch Surg Original Article 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00423-021-02287-6. Springer Berlin Heidelberg 2021-08-18 2022 /pmc/articles/PMC8847165/ /pubmed/34406491 http://dx.doi.org/10.1007/s00423-021-02287-6 Text en © The Author(s) 2021, corrected publication 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article Riordan, Fiona Murphy, Matthew S. Feeley, Linda Sheahan, Patrick Association between number of parathyroid glands identified during total thyroidectomy and functional parathyroid preservation |
title | Association between number of parathyroid glands identified during total thyroidectomy and functional parathyroid preservation |
title_full | Association between number of parathyroid glands identified during total thyroidectomy and functional parathyroid preservation |
title_fullStr | Association between number of parathyroid glands identified during total thyroidectomy and functional parathyroid preservation |
title_full_unstemmed | Association between number of parathyroid glands identified during total thyroidectomy and functional parathyroid preservation |
title_short | Association between number of parathyroid glands identified during total thyroidectomy and functional parathyroid preservation |
title_sort | association between number of parathyroid glands identified during total thyroidectomy and functional parathyroid preservation |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8847165/ https://www.ncbi.nlm.nih.gov/pubmed/34406491 http://dx.doi.org/10.1007/s00423-021-02287-6 |
work_keys_str_mv | AT riordanfiona associationbetweennumberofparathyroidglandsidentifiedduringtotalthyroidectomyandfunctionalparathyroidpreservation AT murphymatthews associationbetweennumberofparathyroidglandsidentifiedduringtotalthyroidectomyandfunctionalparathyroidpreservation AT feeleylinda associationbetweennumberofparathyroidglandsidentifiedduringtotalthyroidectomyandfunctionalparathyroidpreservation AT sheahanpatrick associationbetweennumberofparathyroidglandsidentifiedduringtotalthyroidectomyandfunctionalparathyroidpreservation |