Iatrogenic Parathyroidectomy and Affecting Factors During Thyroid Surgery

Abstract

Aim: This study aimed to investigate cases of iatrogenic parathyroidectomy following thyroid surgery and to analyze the causes. Material and Methods: A total of 287 patients diagnosed with thyroid-related disorders and surgically treated at various clinics of Private Esencan Hospital between 2019 and 2023 were included in the study. Preoperative ultrasound imaging results and data on patients with multinodular goiter presenting a dominant nodule larger than 4 cm in diameter were recorded, specifically noting the presence of thyroiditis. Thyroid tissues obtained during surgery were examined histopathologically in the pathology laboratory, and the presence of thyroid malignancy and parathyroid tissue was confirmed. Results: The mean age of the patients was 55.6±17.3 years, ranging from 18 to 83 years, and 154 (55.4%) were male. Iatrogenic parathyroidectomy was identified in 26 (9.4%) of the patients. The rate of iatrogenic parathyroidectomy was significantly higher in patients with thyroid malignancy compared to those without (13.9% vs. 5.8%; p=0.02). Patients with thyroiditis also had a higher rate of iatrogenic parathyroidectomy than those without (18.2% vs. 7.2%; p=0.012). Additionally, patients with a dominant nodule diameter showed a significantly increased rate of iatrogenic parathyroidectomy compared to those without (27.0% vs. 6.6%; p<0.001). In the logistic regression analysis, the presence of thyroid malignancy (p=0.024), thyroiditis (p=0.015), and dominant nodule diameter (p<0.001) were identified as independent risk factors for developing iatrogenic parathyroidectomy. Conclusion: Our study shows that the risk of iatrogenic parathyroidectomy is significantly higher, especially in patients with thyroiditis, thyroid malignancy, or large nodules. These patients should be handled more carefully during surgery and should be considered for surgical treatment.

Keywords

• thyroid surgery
• thyroidectomy
• iatrogenic parathyroidectomy
• malignancy; thyroiditis; hypocalcemia

References

1. 1. Viqar S, Masood A, Zia N. Early and late complications of thyroidectomy: A descriptive cohort study in Rawalpindi. J Pak Med Assoc. 2022;72:2184–8.
2. 2. Bawa D, Alghamdi A, Albishi H, Al-Tufail N, Sharma SP, Khalifa YM, et al. Post-thyroidectomy complications in southwestern Saudi Arabia: a retrospective study of a 6-year period. A Saudi Med. 2021;41:369–75.
3. 3. Ernandes-Neto M, Tagliarini JV, López BE, Padovani CR, Marques Mde A, Castilho EC, et al. Factors influencing thyroidectomy complications. 2012;78:63–9. BJ
4. 4. Dedivitis RA, Aires FT, Cernea CR. Hypoparathyroidism after thyroidectomy: prevention, assessment and management. C Opin Otolaryngol Head Neck Surg. 2017;25:142–6.
5. 5. Rao SS, Rao H, Moinuddin Z, Rozario AP, Augustine T. Preservation of parathyroid glands during thyroid and neck surgery. Front Endocrinol (Lausanne). 2023;31(14):1173950.
6. 6. Sakorafas GH, Stafyla V, Bramis C, Kotsifopoulos N, Kolettis T, Kassaras G. Incidental parathyroidectomy during thyroid surgery: an underappreciated complication of thyroidectomy. World J Surg. 2005;29:1539–43.
7. 7. Sorgato N, Pennelli G, Boschin IM, Ide EC, Pagetta C, Piotto A, et al. Can we avoid inadvertent parathyroidectomy during thyroid surgery? In Vivo. 2009;23:433–9.
8. 8. Ozoğul B, Nuran Akçay M, Kisaoğlu A, Atamanalp SS, Oztürk G, Aydinli B. Incidental parathyroidectomy during thyroid surgery: risk factors, incidence, and outcomes. Turk J Med Sci. 2014;44:84–8.

9. 9. Hone RW, Tikka T, Kaleva AI, Hoey A, Alexander V, Balfour A, et al. Analysis of the incidence and factors predictive of inadvertent parathyroidectomy during thyroid surgery. J Laryngol Otol. 2016;130:669–73.
10. 10. Zheng J, Song H, Cai S, Wang Y, Han X, Wu H, et al. Evaluation of clinical significance and risk factors of incidental parathyroidectomy due to thyroidectomy: A singlecenter retrospective clinical study. Medicine (Baltimore). 2017;96:e8175.
11. 11. McGoldrick DM, Majeed M, Achakzai AA, Redmond HP. Inadvertent parathyroidectomy during thyroid surgery. Ir J Med Sci. 2017;186:1019–22.
12. 12. Applewhite MK, White MG, Xiong M, Pasternak JD, Abdulrasool L, Ogawa L, et al. Incidence, Risk Factors, and Clinical Outcomes of Incidental Parathyroidectomy During T hyroid Surgery. Ann Surg Oncol. 2016;23:4310–5.
13. 13. Caulley L, Johnson-Obaseki S, Luo L, Javidnia H. Risk factors for postoperative complications in total thyroidectomy: A retrospective, risk-adjusted analysis from the National Surgical Quality Improvement Program. Medicine (Baltimore). 2017;96:e5752.
14. 14. Marian D, Scurtu GA, Fulop RL, Fulop ZZ, Andercou O. Incidental parathyroidectomy is a frequent complication of thyroid surgery. A retrospective study of 3065 patients. Ann Ital Chir. 2023;94:240–4. Otorhinolaryngol.
15. 15. Ondik MP, McGinn J, Ruggiero F, Goldenberg D. Unintentional parathyroidectomy and hypoparathyroidism in secondary central compartment surgery for thyroid cancer. Head Neck. 2010;32:462–6.
16. 16. Ziai H, Dixon P, Berman G, Campisi P, Wasserman JD. Incidental Parathyroidectomy Among Pediatric Patients Undergoing T hyroid Surgery. Laryngoscope. 2022;132(11):2262–9.
17. 17. Gourgiotis S, Moustafellos P, Dimopoulos N, Papaxoinis G, Baratsis S, Hadjiyannakis E. Inadvertent parathyroidectomy during thyroid surgery: the incidence of a complication of thyroidectomy. Langenbecks Arch Surg. 2006;391:557–60.
18. 18. Kim SW, et al. Intraoperative real-time localization of parathyroid glands using near-infrared autofluorescence imaging. J Clin Endocrinol Metab. 2016;101(12):4646–4652.
19. 19. Thomas G, et al. Use of indocyanine green fluorescence imaging to detect parathyroid glands during thyroidectomy. Surgery. 2019;165(2):361–368.
20. 20. Benmiloud F, et al. Impact of autofluorescence-based identification of parathyroids during total thyroidectomy on postoperative hypocalcemia: a before and after controlled study. Surgery. 2018;163(1):23–30