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An Undesirable Post-Thyroidectomy Surprise for the Surgeon: Inadvertent Parathyroidectomy

Year 2018, Volume: 71 Issue: 3, 244 - 250, 31.12.2018

Abstract

Objectives: This study aims to report the incidence of inadvertent parathyroid gland removal during thyroidectomies, as documented by pathology reports, and investigate its association with hypocalcemia.

Materials and Methods: The patients who underwent thyroidectomy at our department between 2009 and 2013 were retrospectively reviewed. The patients who had standard total thyroidectomy were included in the study. Data on patient demographics, surgical reports, experience of surgeons, anatomical localization of excised parathyroid glands (PG) and laboratory results were evaluated. Patients were divided into two groups according to the presence or absence of an excised PG in the histopathology report (group P: presence of PG, and group T: absence of PG).

Results: A total of 343 patients were included to study. Of these, 26 patients were in group P, and 317 in group T. Post-operative hypocalcemia was encountered in 37 patients. Hypocalcemia rates were similar between two groups (p=0.45). Surgical experience was found to decrease the rate of Inadvertent parathyroidectomy (IP) (p=0.04), however, it wasn’t associated with post-operative hypocalcemia (p=0.72).

Conclusion: IP is an undesirable finding that can be encountered by surgeons. Our findings showed that IP was found to be associated with surgical experience. However, these results were not associated with post-operative hypocalcemia.

Key Words: Inadvertent Parathyroidectomy, Thyroidectomy, Hypocalcemia, İntraoperative Complication

Ethical Statement

In terms of anonymized data usage for the study, no local ethics committee approval was obtained.

Supporting Institution

-

Project Number

-

Thanks

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References

  • 1. Altaca G, Onat D. Tiroidektomi ve komplikasyonlari. In: Sayek I (ed) Temel Cerrahi, 4th Edn. Ankara: Gunes Kitabevi; 2013. p. 1924 - 35
  • 2. Ozogul B, Akcay MN, Akcay G, et al. Factors affecting hypocalcaemia following total thyroidectomy: A prospective study. Eurasian J Med. 2014;46:15-21.
  • 3. Sippel RS, Ozgul O, Hartig GK, et al. Risks and consequences of incidental parathyroidectomy during thyroid resection. ANZ J Surg. 2007;77:33-36.
  • 4. Erbil Y, Barbaros U, Issever H, et al. Predictive factors for recurrent laryngeal nerve palsy and hypoparathyroidism after thyroid surgery. Clin Otolaryngol. 2007;32:32-37.
  • 5. Shaha A, Jaffe BM. Complications of thyroid surgery performed by residents. Surgery. 1988;104:1109–1114.
  • 6. Yazici P, Bozkurt E, Citgez B, et al. Incidental parathyroidectomy as a cause of postoperative hypocalcemia after thyroid surgery: Reality or illusion? Minerva Chir. 2014;69:315-320.
  • 7. Bender O, Yuney E, Capar H, et al. Our experience on total thyroidectomy. Endokrinolojide Diyalog. 2004;1:15-18.
  • 8. Lal G, Clark OH. Thyroid, Parathyroid and Adrenal. In: Brunicardi CF (ed), Schwartz’s Principles of Surgery, 10th Edn. New York: Mc Graw Hill; 2015. p.1521-97.
  • 9. Pattou F, Combemale F, Fabre S, et al. Hypocalcemia following thyroid surgery: Incidence and prediction of outcome. World J Surg. 1998;22:718-724.
  • 10. Shaha AR, Jaffe BM. Parathyroid preservation during thyroid surgery. Am J Otolaryngol. 1998;19:113-117.
  • 11. Harness JK, Fung L, Thompson NW, et al. Total thyroidectomy: Complications and technique. World J Surg. 1986;10:781-786.
  • 12. Edis AJ. Prevention and management of complications associated with thyroid and parathyroid surgery. Surg Clin North Am. 1979;59:83-92.
  • 13. Abboud B, Sargi Z, Akkam M, et al. Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg. 2002;195:456–461.
  • 14. Kupferman ME, Mandel SJ, DiDonato L, et al. Safety of completion thyroidectomy following unilateral lobectomy for well-differentiated thyroid cancer. Laryngoscope. 2002;112:1209–1212.
  • 15. Bergamaschi R, Becouarn G, Ronceray J, et al. Morbidity of thyroid surgery. Am J Surg. 1998;176:71–75.
  • 16. Zhou HY, He JC, McHenry CR. Inadvertent parathyroidectomy: incidence, risk factors, and outcomes. J Surg Res. 2016;205:70-75.
  • 17. Sasson AR, Pingpank JF, Wetherington RW, et al. Incidental parathyroidectomy during thyroid surgery does not cause transient symptomatic hypocalcemia. Arch Otolaryngol Head Neck Surg. 2001;127:304-308.
  • 18. Hone RW, Tikka T, Kaleva AI, et al. Analysis of the incidence and factors predictive of inadvertent parathyroidectomy during thyroid surgery. J Laryngol Otol. 2016;130:669-673.
  • 19. McGoldrick DM, Majeed M, Achakzai AA, Redmond HP. Inadvertent parathyroidectomy during thyroid surgery. Ir J Med Sci. 2017;186:1019- 1022
  • 20. Bliss RD, Gauger PG, Delbridge LW. Surgeon’s approach to the thyroid gland: surgical anatomy and the importance of technique. World J Surg. 2000;24:891-897.
  • 21. Dural AC, Akarsu C, Unsal MG, et al. Multidisciplinary management of surgery for thyroid diseases: Analysis of five years with the experience of Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Endokrinolojide Diyalog. 2015;12:1-8.
  • 22. Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A. Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg. 2015;102:359-367.
  • 23. Prim MP, de Diego JI, Hardisson D, et al. Factors related to nerve injury and hypocalcemia in thyroid gland surgery. Otolaryngol Head Neck Surg. 2001;124:111-114.
  • 24. Thomusch O, Machens A, Sekulla C, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: Prospective multicenter study in Germany. World J Surg. 2000;24:1335–341.
  • 25. Lin DT, Patel SG, Shaha AR, et al. Incidence of inadvertent parathyroid removal during thyroidectomy. Laryngoscope. 2002;112:608–611.
  • 26. Herranz-Gonzalez J, Gavilán J, Martínez-Vidal J, et al. Complications following thyroid surgery. Arch Otolaryngol Head Neck Surg. 1991;117:516-518.
  • 27. Van Heerden JA, Groh MA, Grant CS. Early postoperative morbidity after surgical treatment of thyroid carcinoma. Surgery. 1987;101:224-227.
  • 28. Shemen LJ, Strong EW. Complications after total thyroidectomy. Otolaryngol Head Neck Surg. 1989;101:472-475.
  • 29. Konan A, Usman A, Sayek I. Paratiroid hastaliklari. In: Sayek I (ed) Temel Cerrahi, 4th Edn. Ankara: Gunes Kitabevi; 2013. p. 1935-55
  • 30. Edafe O, Antakia R, Laskar N, et al. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcemia. Br J Surg. 2014;101:307-320.
  • 31. Ahmed N, Aurangzeb M, Muslim M, et al. Routine parathyroid auto transplantation during total thyroidectomy: A procedure with predictable outcome. J Pak Med Assoc. 2013;63:190-193.
  • 32. Oran E, Yetkin G, Mihmanli M, et al. The risk of hypocalcemia in patients with parathyroid autotransplantation during thyroidectomy. Ulus Cer Derg. 2015;32:6-10.
  • 33. Kalyoncu D, Gonullu D, Gedik ML, et al. Analysis of the factors that have an effect on hypocalcemia following thyroidectomy. Ulus Cer Derg. 2013;29:171-176.

Tiroidektomi Sonrasında Cerrah Açısından Hoş Olmayan Bir Sürpriz: İstemeden Yapılan Paratiroidektomi

Year 2018, Volume: 71 Issue: 3, 244 - 250, 31.12.2018

Abstract

Amaç: Bu çalışmada tiroidektomi sırasında istenmeden çıkartılan ve patoloji raporlarında saptanan paratiroid bezlerinin insidansının saptanması ve hipokalsemi gelişimi ile ilişkisinin belirlenmesi amaçlanmıştır.

Gereç ve Yöntem: Kliniğimizde 2009 ile 2013 yılları arasında tiroidektomi uygulanan hastalar retrospektif olarak değerlendirildi. Standart total tiroidektomi yapılan olgular çalışmaya dahil edildi. Hastalara ait demografik veriler, ameliyat raporları, cerrahların deneyimi, eksize edilen paratiroid bezinin (PB) anatomik lokalizasyonu ve laboratuvar sonuçları değerlendirildi. Hastalar histopatoloji raporunda paratiroid bezi saptanan ve saptanmayanlar olmak üzere iki gruba ayrıldı. (grup P: PB saptananlar, and group T: PB saptanmayanlar).

Bulgular: Çalışmaya toplam 343 hasta dahil edildi. Bunlar içerisinden, 26 hasta grup P’de, 317’si ise grup T’de yer aldı. Otuz yedi hastada postoperatif dönemde hipokalsemi saptandı. Hipokalsemi oranları her iki grupta benzerdi (p=0,45). Cerrahi deneyimin istemeden yapılan paratiroidektomi (İP) oranını düşürdüğü görüldü (p=0,04), ancak postoperatif hipokalsemi ile ilişkisi saptanmadı (p=0,72).

Sonuç: İstemeden yapılan paratiroidektomi cerrahlar açısından hoş sonuçlanmayan bir durumdur. Çalışmamıza ait sonuçlar cerrahi tecrübe arttıkça İP oranının azaldığı yönündedir. Ancak bu durum postoperatif hipokalsemi ile ilişkisiz bulunmuştur.

Anahtar Kelimeler: İstemeden Yapılan Paratiroidektomi, Tiroidektomi, Hipokalsemi, İntraoperatif Komplikasyon

Ethical Statement

-

Supporting Institution

-

Project Number

-

Thanks

-

References

  • 1. Altaca G, Onat D. Tiroidektomi ve komplikasyonlari. In: Sayek I (ed) Temel Cerrahi, 4th Edn. Ankara: Gunes Kitabevi; 2013. p. 1924 - 35
  • 2. Ozogul B, Akcay MN, Akcay G, et al. Factors affecting hypocalcaemia following total thyroidectomy: A prospective study. Eurasian J Med. 2014;46:15-21.
  • 3. Sippel RS, Ozgul O, Hartig GK, et al. Risks and consequences of incidental parathyroidectomy during thyroid resection. ANZ J Surg. 2007;77:33-36.
  • 4. Erbil Y, Barbaros U, Issever H, et al. Predictive factors for recurrent laryngeal nerve palsy and hypoparathyroidism after thyroid surgery. Clin Otolaryngol. 2007;32:32-37.
  • 5. Shaha A, Jaffe BM. Complications of thyroid surgery performed by residents. Surgery. 1988;104:1109–1114.
  • 6. Yazici P, Bozkurt E, Citgez B, et al. Incidental parathyroidectomy as a cause of postoperative hypocalcemia after thyroid surgery: Reality or illusion? Minerva Chir. 2014;69:315-320.
  • 7. Bender O, Yuney E, Capar H, et al. Our experience on total thyroidectomy. Endokrinolojide Diyalog. 2004;1:15-18.
  • 8. Lal G, Clark OH. Thyroid, Parathyroid and Adrenal. In: Brunicardi CF (ed), Schwartz’s Principles of Surgery, 10th Edn. New York: Mc Graw Hill; 2015. p.1521-97.
  • 9. Pattou F, Combemale F, Fabre S, et al. Hypocalcemia following thyroid surgery: Incidence and prediction of outcome. World J Surg. 1998;22:718-724.
  • 10. Shaha AR, Jaffe BM. Parathyroid preservation during thyroid surgery. Am J Otolaryngol. 1998;19:113-117.
  • 11. Harness JK, Fung L, Thompson NW, et al. Total thyroidectomy: Complications and technique. World J Surg. 1986;10:781-786.
  • 12. Edis AJ. Prevention and management of complications associated with thyroid and parathyroid surgery. Surg Clin North Am. 1979;59:83-92.
  • 13. Abboud B, Sargi Z, Akkam M, et al. Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg. 2002;195:456–461.
  • 14. Kupferman ME, Mandel SJ, DiDonato L, et al. Safety of completion thyroidectomy following unilateral lobectomy for well-differentiated thyroid cancer. Laryngoscope. 2002;112:1209–1212.
  • 15. Bergamaschi R, Becouarn G, Ronceray J, et al. Morbidity of thyroid surgery. Am J Surg. 1998;176:71–75.
  • 16. Zhou HY, He JC, McHenry CR. Inadvertent parathyroidectomy: incidence, risk factors, and outcomes. J Surg Res. 2016;205:70-75.
  • 17. Sasson AR, Pingpank JF, Wetherington RW, et al. Incidental parathyroidectomy during thyroid surgery does not cause transient symptomatic hypocalcemia. Arch Otolaryngol Head Neck Surg. 2001;127:304-308.
  • 18. Hone RW, Tikka T, Kaleva AI, et al. Analysis of the incidence and factors predictive of inadvertent parathyroidectomy during thyroid surgery. J Laryngol Otol. 2016;130:669-673.
  • 19. McGoldrick DM, Majeed M, Achakzai AA, Redmond HP. Inadvertent parathyroidectomy during thyroid surgery. Ir J Med Sci. 2017;186:1019- 1022
  • 20. Bliss RD, Gauger PG, Delbridge LW. Surgeon’s approach to the thyroid gland: surgical anatomy and the importance of technique. World J Surg. 2000;24:891-897.
  • 21. Dural AC, Akarsu C, Unsal MG, et al. Multidisciplinary management of surgery for thyroid diseases: Analysis of five years with the experience of Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Endokrinolojide Diyalog. 2015;12:1-8.
  • 22. Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A. Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg. 2015;102:359-367.
  • 23. Prim MP, de Diego JI, Hardisson D, et al. Factors related to nerve injury and hypocalcemia in thyroid gland surgery. Otolaryngol Head Neck Surg. 2001;124:111-114.
  • 24. Thomusch O, Machens A, Sekulla C, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: Prospective multicenter study in Germany. World J Surg. 2000;24:1335–341.
  • 25. Lin DT, Patel SG, Shaha AR, et al. Incidence of inadvertent parathyroid removal during thyroidectomy. Laryngoscope. 2002;112:608–611.
  • 26. Herranz-Gonzalez J, Gavilán J, Martínez-Vidal J, et al. Complications following thyroid surgery. Arch Otolaryngol Head Neck Surg. 1991;117:516-518.
  • 27. Van Heerden JA, Groh MA, Grant CS. Early postoperative morbidity after surgical treatment of thyroid carcinoma. Surgery. 1987;101:224-227.
  • 28. Shemen LJ, Strong EW. Complications after total thyroidectomy. Otolaryngol Head Neck Surg. 1989;101:472-475.
  • 29. Konan A, Usman A, Sayek I. Paratiroid hastaliklari. In: Sayek I (ed) Temel Cerrahi, 4th Edn. Ankara: Gunes Kitabevi; 2013. p. 1935-55
  • 30. Edafe O, Antakia R, Laskar N, et al. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcemia. Br J Surg. 2014;101:307-320.
  • 31. Ahmed N, Aurangzeb M, Muslim M, et al. Routine parathyroid auto transplantation during total thyroidectomy: A procedure with predictable outcome. J Pak Med Assoc. 2013;63:190-193.
  • 32. Oran E, Yetkin G, Mihmanli M, et al. The risk of hypocalcemia in patients with parathyroid autotransplantation during thyroidectomy. Ulus Cer Derg. 2015;32:6-10.
  • 33. Kalyoncu D, Gonullu D, Gedik ML, et al. Analysis of the factors that have an effect on hypocalcemia following thyroidectomy. Ulus Cer Derg. 2013;29:171-176.
There are 33 citations in total.

Details

Primary Language English
Subjects Endocrinology
Journal Section Research Article
Authors

Ahmet Cem Dural 0000-0003-3479-725X

Cevher Akarsu 0000-0003-1650-8805

Muhammet Ferhat Çelik This is me 0000-0002-3697-0418

Süleyman Büyükaşık 0000-0001-5536-4395

Mustafa Gökhan Ünsal 0000-0002-6691-7511

Hürriyet Turgut This is me 0000-0001-6561-8408

Yıldız Okuturlar 0000-0002-1994-0014

Halil Alış 0000-0002-8008-2776

Project Number -
Publication Date December 31, 2018
Published in Issue Year 2018 Volume: 71 Issue: 3

Cite

APA Dural, A. C., Akarsu, C., Çelik, M. F., … Büyükaşık, S. (2018). An Undesirable Post-Thyroidectomy Surprise for the Surgeon: Inadvertent Parathyroidectomy. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 71(3), 244-250. https://doi.org/10.4274/atfm.03511
AMA Dural AC, Akarsu C, Çelik MF, et al. An Undesirable Post-Thyroidectomy Surprise for the Surgeon: Inadvertent Parathyroidectomy. Ankara Üniversitesi Tıp Fakültesi Mecmuası. December 2018;71(3):244-250. doi:10.4274/atfm.03511
Chicago Dural, Ahmet Cem, Cevher Akarsu, Muhammet Ferhat Çelik, Süleyman Büyükaşık, Mustafa Gökhan Ünsal, Hürriyet Turgut, Yıldız Okuturlar, and Halil Alış. “An Undesirable Post-Thyroidectomy Surprise for the Surgeon: Inadvertent Parathyroidectomy”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71, no. 3 (December 2018): 244-50. https://doi.org/10.4274/atfm.03511.
EndNote Dural AC, Akarsu C, Çelik MF, Büyükaşık S, Ünsal MG, Turgut H, Okuturlar Y, Alış H (December 1, 2018) An Undesirable Post-Thyroidectomy Surprise for the Surgeon: Inadvertent Parathyroidectomy. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71 3 244–250.
IEEE A. C. Dural, C. Akarsu, M. F. Çelik, S. Büyükaşık, M. G. Ünsal, H. Turgut, Y. Okuturlar, and H. Alış, “An Undesirable Post-Thyroidectomy Surprise for the Surgeon: Inadvertent Parathyroidectomy”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 71, no. 3, pp. 244–250, 2018, doi: 10.4274/atfm.03511.
ISNAD Dural, Ahmet Cem et al. “An Undesirable Post-Thyroidectomy Surprise for the Surgeon: Inadvertent Parathyroidectomy”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71/3 (December2018), 244-250. https://doi.org/10.4274/atfm.03511.
JAMA Dural AC, Akarsu C, Çelik MF, Büyükaşık S, Ünsal MG, Turgut H, Okuturlar Y, Alış H. An Undesirable Post-Thyroidectomy Surprise for the Surgeon: Inadvertent Parathyroidectomy. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2018;71:244–250.
MLA Dural, Ahmet Cem et al. “An Undesirable Post-Thyroidectomy Surprise for the Surgeon: Inadvertent Parathyroidectomy”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 71, no. 3, 2018, pp. 244-50, doi:10.4274/atfm.03511.
Vancouver Dural AC, Akarsu C, Çelik MF, Büyükaşık S, Ünsal MG, Turgut H, et al. An Undesirable Post-Thyroidectomy Surprise for the Surgeon: Inadvertent Parathyroidectomy. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2018;71(3):244-50.