Unpredictable nightmare in thyroid surgery: Incidental Parathyroidectomy

Öz

Background: Incidental removal of the parathyroid gland is an unwanted minor complication of thyroidectomy and would occur even in experienced centers. The purpose of this study was to evaluate our clinic’s outcomes, incidence, and risk factors for incidental parathyroidectomy. Methods: A total of 627 patients with an average age of 50.74±12.68 years were included in the study. Seventy-eight point nine percent of the patients had bilateral total thyroidectomy, 11.2% had a total lobectomy with isthmectomy, 4.8% had completed thyroidectomy, 4% had bilateral total thyroidectomy with bilateral central dissection and 1.1% had bilateral subtotal thyroidectomy. Incidental parathyroidectomy was observed in 6.4% (n=40) of all patients. Results: There was a significant correlation between incidental parathyroidectomy and bilateral total thyroidectomy and bilateral central neck dissection. There were no statistically significant differences between the incidental and nonincidental parathyroidectomy group with respect to age and gender. While the preoperative diagnosis of hyperthyroidism (20.6% vs 7.5%) was significantly higher in the non-incidental parathyroidectomy group than in the incidental parathyroidectomy group, and the diagnosis of malignancy was significantly higher in the incidental parathyroidectomy group (32.5% vs. 11.6%, p=0.001). Regarding parathyroid localization, our incidental parathyroidectomy rate was higher in intrathyroidal localized cases. Postoperative transient hypocalcemia (62.5%) was higher in the incidental parathyroidectomy group than in the non-incidental parathyroidectomy group (34.4%, p<0.001). Conclusion: Total thyroidectomy, thyroid pathology, and intrathyroidal parathyroid location are risk factors for incidental parathyroidectomy. Incidental parathyroidectomy during thyroid surgery can be a potential complication.

Anahtar Kelimeler

• Parathyroidectomy
• incidental
• hypocalcemia

Tiroid cerrahisinin önlenemez kabusu: İnsidental Paratiroidektomi

Öz

Amaç: Paratiroid bezinin tesadüfen çıkarılması, tiroidektominin istenmeyen küçük bir komplikasyonudur ve deneyimli merkezlerde bile meydana gelebilir. Bu çalışmanın amacı, kliniğimizin tesadüfi paratiroidektomi sonuçlarını, insidansını ve risk faktörlerini değerlendirmektir. Yöntem: Çalışmaya yaş ortalaması 50,74±12,68 olan toplam 627 hasta dahil edildi. Hastaların yüzde yetmiş sekiz nokta dokuzuna bilateral total tiroidektomi, %11,2'sine total lobektomi ile istmektomi, %4,8'ine tamamlayıcı tiroidektomi, %4'üne total tiroidektomi ile birlikte bilateral santral diseksiyonla ve %1,1'ine de bilateral subtotal tiroidektomi uygulandı. Tüm hastaların %6,4'ünde (n=40) rastlantısal paratiroidektomi görüldü. Bulgular: Tesadüfi paratiroidektomi ile bilateral total tiroidektomi ve bilateral santral boyun diseksiyonu arasında anlamlı bir korelasyon vardı. Yaş ve cinsiyet açısından tesadüfi ve tesadüfi olmayan paratiroidektomi grubu arasında istatistiksel olarak anlamlı bir fark yoktu. Preoperatif hipertiroidizm tanısı (%20,6'ya karşı %7,5) tesadüfi olmayan paratiroidektomi grubunda tesadüfi paratiroidektomi grubuna göre anlamlı olarak yüksek bulunurken, tesadüfi paratiroidektomi grubunda malignite tanısı anlamlı olarak daha yüksekti (%32,5'e karşı %11,6, p=0.001). Paratiroid lokalizasyonu açısından intratiroidal lokalize vakalarda tesadüfi paratiroidektomi oranımız daha yüksekti. Postoperatif geçici hipokalsemi (%62,5) tesadüfi paratiroidektomi grubunda tesadüfi olmayan paratiroidektomi grubuna göre daha yüksekti (%34,4, p<0,001). Sonuç: Total tiroidektomi, tiroid patolojisi ve intratiroidal yerleşimi paratiroid tesadüfi paratiroidektomi için risk faktörleridir. Tiroid cerrahisi sırasında rastlantısal paratiroidektomi potansiyel bir komplikasyon olabilir.

Anahtar Kelimeler

• Paratiroidektomi
• tesadüfi
• hipokalsemi

Kaynakça

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