Permanent Hypoparathyroidism After Thyroidectomy: An Avoidable Complication

Abstract

Abstract

Introduction

: Hypoparathyroidism (HP) is a recognized but serious complication of thyroidectomy. Conventional techniques for parathyroid autograft (PA) occur with the insertion of parathyroid slices in muscle pockets and have a published incidence of HP of 4%–8%. The purpose of this study was to analyze the incidence of HP after thyroidectomy at our center, where we have used a modified technique for PA.

Materials and Methods:

Our PA technique was adapted from tissue culture methods. We minced parathyroid glands very finely in saline to 1 mm fragments and reimplanted them into the ipsilateral sternocleidomastoid muscle using an angiocatheter. PA was used when a parathyroid appeared to be ischemic or to have venous congestion in situ.

Results

: Between 2008 and 2014, 856 patients underwent thyroidectomy. PA was done during 286 operations (33.5%): 211 single glands, 66 double implants, and 9 triple glands. Inferior parathyroid glands required PA more frequently than superior glands (54% vs 26%). PA was done more frequently during total thyroidectomy than during lobectomy (odds ratio 16.5, p ≤ 0.001). Neither the thyroid tissue diagnosis nor the need for lymph node dissection increased the use of PA. Transient hypocalcemia (Ca⁺⁺ < 7.0) occurred in 14% of total thyroidectomies with PA and in 7% of total thyroidectomies without PA. No patient suffered HP after thyroid lobectomy or total thyroidectomy.

Conclusions

: Our technique for PA was effective in preserving parathyroid tissue viability and preventing HP in our thyroidectomy patients. We recommend it to our colleagues performing thyroid surgery.

All authors declare no conflict of interest.

Runtime of video: 5 mins 43 secs