Clin Exp Otorhinolaryngol.  2017 Sep;10(3):265-271. 10.21053/ceo.2016.00724.

Postoperative Hypoparathyroidism and the Viability of the Parathyroid Glands During Thyroidectomy

• Ji YB
• Song CM
• Sung ES
• Jeong JH
• Lee CB
• Tae K

• KMID: 2395742
• DOI: http://doi.org/10.21053/ceo.2016.00724

Abstract

OBJECTIVES
To prevent hypoparathyroidism after thyroidectomy, preservation of the parathyroid glands and their vascularity are essential. The aim of this study was to determine the association between postoperative parathyroid function and the viability of the parathyroid glands during thyroidectomy.
METHODS
We prospectively analyzed 111 patients who underwent total thyroidectomy and in whom all 4 parathyroid glands were preserved in situ during the operation. The surgeons scored the viability of each parathyroid gland from 0 (normal) to 3 (severely compromised viability) based on its gross appearance and vascularity intraoperatively. The index of parathyroid viability score (IPVS) was defined as the sum of the viability scores of the 4 parathyroid glands. We evaluated the relationship between postoperative parathyroid function and IPVS.
RESULTS
Transient hypoparathyroidism occurred in 25 patients (22.5%), and permanent hypoparathyroidism in 4 patients (3.6%). The IPVS were significantly different in the three groups: 2.87±1.46 in the normal group, 3.68±1.41 in the transient hypoparathyroidism group and 7.50±1.00 in the permanent hypoparathyroidism group. The rates of transient hypoparathyroidism were 13.6% in patients with IPVS 0-2, 23.8% in patients with IPVS 3-4, and 42.9% in patients with IPVS 5-6. All the patients with IPVS of 7 or more had permanent hypoparathyroidism.
CONCLUSION
IPVS is correlated with the incidence of hypoparathyroidism. It could be a good quantitative indicator of the probability of hypoparathyroidism after thyroidectomy.

Keyword

Parathyroid Glands; Hypoparathyroidism; Hypocalcemia; Thyroidectomy

MeSH Terms

Humans
Hypocalcemia
Hypoparathyroidism*
Incidence
Parathyroid Glands*
Prospective Studies
Surgeons
Thyroidectomy*

Figure

• 

  Fig. 1. Scoring of parathyroid gland viability according to intraoperative gross appearance and vascularity. (A) Black arrow indicates normal parathyroid with score 0, and white arrow indicates moderately compromised parathyroid with score 2. (B) Black arrow head indicates mildly compromised parathyroid with score 1. (C) White arrow head indicates severely compromised parathyroid with score 3.

• 

  Fig. 2. Mean index of parathyroid viability score (IPVS) according to the postoperative parathyroid function. IPVS is significantly different in the three groups.

Reference

1. Kahky MP, Weber RS. Complications of surgery of the thyroid and parathyroid glands. Surg Clin North Am. 1993; Apr. 73(2):307–21.

2. Abboud B, Sleilaty G, Braidy C, Zeineddine S, Ghorra C, Abadjian G, et al. Careful examination of thyroid specimen intraoperatively to reduce incidence of inadvertent parathyroidectomy during thyroid surgery. Arch Otolaryngol Head Neck Surg. 2007; Nov. 133(11):1105–10.

3. 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; Nov. 391(6):557–60.

4. Lee NJ, Blakey JD, Bhuta S, Calcaterra TC. Unintentional parathyroidectomy during thyroidectomy. Laryngoscope. 1999; Aug. 109(8):1238–40.

5. Lin DT, Patel SG, Shaha AR, Singh B, Shah JP. Incidence of inadvertent parathyroid removal during thyroidectomy. Laryngoscope. 2002; Apr. 112(4):608–11.

6. Lo CY, Lam KY. Postoperative hypocalcemia in patients who did or did not undergo parathyroid autotransplantation during thyroidectomy: a comparative study. Surgery. 1998; Dec. 124(6):1081–6.

7. Ji YB, Lee DW, Song CM, Kim KR, Park CW, Tae K. Accuracy of intraoperative determination of central node metastasis by the surgeon in papillary thyroid carcinoma. Otolaryngol Head Neck Surg. 2014; Apr. 150(4):542–7.

8. Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, et al. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg. 1998; Jul. 22(7):718–24.

9. Ji YB, Lee KJ, Park YS, Hong SM, Paik SS, Tae K. Clinical efficacy of sentinel lymph node biopsy using methylene blue dye in clinically node-negative papillary thyroid carcinoma. Ann Surg Oncol. 2012; Jun. 19(6):1868–73.

10. Kuhel WI, Carew JF. Parathyroid biopsy to facilitate the preservation of functional parathyroid tissue during thyroidectomy. Head Neck. 1999; Aug. 21(5):442–6.

11. Shaha AR, Jaffe BM. Parathyroid preservation during thyroid surgery. Am J Otolaryngol. 1998; Mar-Apr. 19(2):113–7.

12. Chia SH, Weisman RA, Tieu D, Kelly C, Dillmann WH, Orloff LA. Prospective study of perioperative factors predicting hypocalcemia after thyroid and parathyroid surgery. Arch Otolaryngol Head Neck Surg. 2006; Jan. 132(1):41–5.

13. Quiros RM, Pesce CE, Wilhelm SM, Djuricin G, Prinz RA. Intraoperative parathyroid hormone levels in thyroid surgery are predictive of postoperative hypoparathyroidism and need for vitamin D supplementation. Am J Surg. 2005; Mar. 189(3):306–9.

14. Bentrem DJ, Rademaker A, Angelos P. Evaluation of serum calcium levels in predicting hypoparathyroidism after total/near-total thyroidectomy or parathyroidectomy. Am Surg. 2001; Mar. 67(3):249–51.

15. Luu Q, Andersen PE, Adams J, Wax MK, Cohen JI. The predictive value of perioperative calcium levels after thyroid/parathyroid surgery. Head Neck. 2002; Jan. 24(1):63–7.

16. 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; Mar. 102(4):359–67.

17. Song CM, Jung JH, Ji YB, Min HJ, Ahn YH, Tae K. Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy. World J Surg Oncol. 2014; Jul. 12:200.

18. Cavicchi O, Piccin O, Caliceti U, De Cataldis A, Pasquali R, Ceroni AR. Transient hypoparathyroidism following thyroidectomy: a prospective study and multivariate analysis of 604 consecutive patients. Otolaryngol Head Neck Surg. 2007; Oct. 137(4):654–8.

19. Page C, Strunski V. Parathyroid risk in total thyroidectomy for bilateral, benign, multinodular goitre: report of 351 surgical cases. J Laryngol Otol. 2007; Mar. 121(3):237–41.

20. Park CH, Song CM, Ji YB, Pyo JY, Yi KJ, Song YS, et al. Significance of the extracapsular spread of metastatic lymph nodes in papillary thyroid carcinoma. Clin Exp Otorhinolaryngol. 2015; Sep. 8(3):289–94.

21. Patel PC, Pellitteri PK, Patel NM, Fleetwood MK. Use of a rapid intraoperative parathyroid hormone assay in the surgical management of parathyroid disease. Arch Otolaryngol Head Neck Surg. 1998; May. 124(5):559–62.

22. Hallgrimsson P, Nordenstrom E, Almquist M, Bergenfelz AO. Risk factors for medically treated hypocalcemia after surgery for Graves’ disease: a Swedish multicenter study of 1,157 patients. World J Surg. 2012; Aug. 36(8):1933–42.

23. Lang BH, Yih PC, Ng KK. A prospective evaluation of quick intraoperative parathyroid hormone assay at the time of skin closure in predicting clinically relevant hypocalcemia after thyroidectomy. World J Surg. 2012; Jun. 36(6):1300–6.

24. Sheahan P, Mehanna R, Basheeth N, Murphy MS. Is systematic identification of all four parathyroid glands necessary during total thyroidectomy? a prospective study. Laryngoscope. 2013; Sep. 123(9):2324–8.

25. Lo CY, Lam KY. Routine parathyroid autotransplantation during thyroidectomy. Surgery. 2001; Mar. 129(3):318–23.

26. Gauger PG, Reeve TS, Wilkinson M, Delbridge LW. Routine parathyroid autotransplantation during total thyroidectomy: the influence of technique. Eur J Surg. 2000; Aug. 166(8):605–9.

27. Promberger R, Ott J, Kober F, Mikola B, Karik M, Freissmuth M, et al. Intra- and postoperative parathyroid hormone-kinetics do not advocate for autotransplantation of discolored parathyroid glands during thyroidectomy. Thyroid. 2010; Dec. 20(12):1371–5.

28. Shaha AR, Burnett C, Jaffe BM. Parathyroid autotransplantation during thyroid surgery. J Surg Oncol. 1991; Jan. 46(1):21–4.

29. Baumann DS, Wells SA Jr. Parathyroid autotransplantation. Surgery. 1993; Feb. 113(2):130–3.

30. Schwartz AE, Friedman EW. Preservation of the parathyroid glands in total thyroidectomy. Surg Gynecol Obstet. 1987; Oct. 165(4):327–32.