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Hicks G, George R, Sywak M. Short and long-term impact of parathyroid autotransplantation on parathyroid function after total thyroidectomy. Gland Surg 2017; 6:S75-S85. [PMID: 29322025 DOI: 10.21037/gs.2017.09.15] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The most common complication of total thyroidectomy is parathyroid insufficiency. Acute, transient, post-operative hypoparathyroidism increases length of hospitalization, morbidity and cost associated with total thyroidectomy. While permanent hypoparathyroidism poses a significant medical burden with lifetime medication, regular follow up and considerable disease burden related to chronic renal failure and other sequelae. Parathyroid autotransplantation has been demonstrated to result in biochemically functional grafts, leading to the procedures' common use during total thyroidectomy. The clearest indications for parathyroid auto transplantation are inadvertently removed or devascularized parathyroid glands. Some centers utilize routine autotransplantation to reduce the risk of permanent hypoparathyroidism. Novel fluorescence techniques to aid in parathyroid detection during thyroid surgery are under evaluation. This review aims to define the role and impact of parathyroid autotransplantation undertaken during total thyroidectomy.
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Affiliation(s)
- Gabrielle Hicks
- Endocrine Surgical Unit, University of Sydney, St Leonards, New South Wales, Australia
| | - Robert George
- Endocrine Surgical Unit, University of Sydney, St Leonards, New South Wales, Australia
| | - Mark Sywak
- Endocrine Surgical Unit, University of Sydney, St Leonards, New South Wales, Australia
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Sadowski SM, Vidal Fortuny J, Triponez F. A reappraisal of vascular anatomy of the parathyroid gland based on fluorescence techniques. Gland Surg 2017; 6:S30-S37. [PMID: 29322020 DOI: 10.21037/gs.2017.07.10] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Identification of the parathyroid glands (PGs) during thyroid surgery may prevent their inadvertent surgical removal and prevent postoperative hypoparathyroidism. However, identification of the PGs does not guarantee their function, and their vascular supply needs to be preserved as well. The recent introduction of intraoperative indocyanine green (ICG) fluorescent angiography of the PGs during thyroid surgery allows for the appraisal of the vascular anatomy and evaluation of PG function. The use of this tool could lead to a significant reduction in the rate of postoperative hypoparathyroidism, as it allows surgeons to adapt their surgical technique for the preservation of the PGs. ICG fluorescent angiography is currently the only available real-time tool to assess the vascular blood supply of each individual PG intraoperatively and can thus assist surgeons in their decision-making. Herein, we review the relevant literature.
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Affiliation(s)
| | - Jordi Vidal Fortuny
- Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Frederic Triponez
- Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland
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53
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Sitges-Serra A. The PGRIS and parathyroid splinting concepts for the analysis and prognosis of protracted hypoparathyroidism. Gland Surg 2017; 6:S86-S93. [PMID: 29322026 DOI: 10.21037/gs.2017.07.16] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Most patients with hypocalcemia after total thyroidectomy will recover the parathyroid function in a few weeks, but some 20-30% of them will still be in the need for replacement therapy one month after surgery and about 5-10% of those will develop permanent hypoparathyroidism. Although postoperative hypocalcemia has been related to several demographic and metabolic causes, parathyroid hormone (PTH) decline, resulting from autotransplantation, inadvertent excision or devascularization of the parathyroid glands, is the common final pathway. The number of parathyroid glands remaining in situ (PGRIS) is a key variable to understand the pathogenesis of protracted hypoparathyroidism and the chances for restoration of the parathyroid function. Normal-high serum calcium concentration, probably achieved by a more intensive medical treatment at the time of hospital discharge, has been identified as an independent variable favoring recovery of the parathyroid function. This we refer to as parathyroid splinting, a hypothesis holding that putting the injured parathyroid parenchyma at rest after thyroidectomy may improve long-term outcome of protracted hypoparathyroidism.
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Abstract
Benign goiter is the most common endocrine disease that requires surgery, especially in endemic areas suffering from iodine-deficiency. Recent European and American guidelines recommended total thyroidectomy for the surgical treatment of multinodular goiter. Total thyroidectomy has now become the technique of choice and is widely considered the most reliable approach in preventing recurrence. Nevertheless, total thyroidectomy carries a substantial risk in terms of hypoparathyroidism and the morbidity associated with injury to the inferior laryngeal nerve. In this context, partial/less-than-total thyroidectomy is being considered once again as a viable alternative. This review will discuss the extent of thyroid surgery for benign disease and the impact of the surgical protocol on the patient- and surgeon-specific risk factors for specific complication rates.
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Affiliation(s)
- Özer Makay
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Turkey
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Benmiloud F, Rebaudet S, Varoquaux A, Penaranda G, Bannier M, Denizot A. Impact of autofluorescence-based identification of parathyroids during total thyroidectomy on postoperative hypocalcemia: a before and after controlled study. Surgery 2017; 163:23-30. [PMID: 29122325 DOI: 10.1016/j.surg.2017.06.022] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/15/2017] [Accepted: 06/26/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The clinical impact of intraoperative autofluorescence-based identification of parathyroids using a near-infrared camera remains unknown. METHODS In a before and after controlled study, we compared all patients who underwent total thyroidectomy by the same surgeon during Period 1 (January 2015 to January 2016) without near-infrared (near-infrared- group) and those operated on during Period 2 (February 2016 to September 2016) using a near-infrared camera (near-infrared+ group). In parallel, we also compared all patients who underwent surgery without near-infrared during those same periods by another surgeon in the same unit (control groups). Main outcomes included postoperative hypocalcemia, parathyroid identification, autotransplantation, and inadvertent resection. RESULTS The near-infrared+ group displayed significantly lower postoperative hypocalcemia rates (5.2%) than the near-infrared- group (20.9%; P < .001). Compared with the near-infrared- patients, the near-infrared+ group exhibited an increased mean number of identified parathyroids and reduced parathyroid autotransplantation rates, although no difference was observed in inadvertent resection rates. Parathyroids were identified via near-infrared before they were visualized by the surgeon in 68% patients. In the control groups, parathyroid identification improved significantly from Period 1 to Period 2, although autotransplantation, inadvertent resection and postoperative hypocalcemia rates did not differ. CONCLUSION Near-infrared use during total thyroidectomy significantly reduced postoperative hypocalcemia, improved parathyroid identification and reduced their autotransplantation rate.
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Affiliation(s)
- Fares Benmiloud
- Endocrine Surgery Unit, Hôpital Européen de Marseille, Marseilles, France.
| | - Stanislas Rebaudet
- Internal Medicine Unit, Hôpital Européen de Marseille, Marseilles, France
| | - Arthur Varoquaux
- Radiology Unit, Hôpital La Timone, Hospital-APHM, Marseilles, France
| | | | - Marie Bannier
- Oncologic Surgery Unit, Institut Paoli-Calmettes, Marseilles, France
| | - Anne Denizot
- Endocrine Surgery Unit, Hôpital Européen de Marseille, Marseilles, France
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56
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Lee YS, Lee BJ, Hong HJ, Lee KD. Current trends of practical issues concerning micropapillary thyroid carcinoma: The Korean Society of Thyroid-Head and Neck Surgery. Medicine (Baltimore) 2017; 96:e8596. [PMID: 29137085 PMCID: PMC5690778 DOI: 10.1097/md.0000000000008596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Although several thyroid associations have published various guidelines, controversies especially in cases of micropapillary thyroid cancer (MPTC) still exist. This survey was designed to collect information about diagnostic tests and treatments performed on patients with MPTC and help identify current trends in thyroid surgery.We developed questionnaires about the management methods for MPTC, which were used to identify factors related to indications of fine needle aspiration (FNA), type of surgery, and central lymph node dissection (CLND). Active 60 members of the Korean Society of Thyroid-Head and Neck Surgery participated in the study in September 2016.Ultrasound-guided FNA was usually initiated when the tumor was at least 5 mm (60%). All respondents preferred ultrasound-guided FNA and surgery for nodules with extrathyroidal extension (ETE). The preferred treatment option for intraglandular MPTC was lobectomy (92%) rather than active surveillance (8%). Posterolateral ETE increased the respondents' preference for total thyroidectomy (61.7%). Active surveillance was preferred for tumors <5 mm, which was decreased by the presence of ETE. The presence of ETE (73.3%) and its proximity to critical organs (46.7%) were the main determining factors for prophylactic CLND. For multiple metastatic lymph nodes at level III, selective neck dissection including levels IIb (23.3%) and V (78.3%) was preferred in addition to levels IIa, III, VI, and V.Korean head and neck surgeons favored total thyroidectomy and CLND in cases wherein ETE, central lymph node metastasis, or critical organ involvement was suspected.
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Affiliation(s)
- Yoon Se Lee
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul
| | - Byung-Joo Lee
- Department of Otorhinolaryngology—Head and Neck Surgery, Pusan National University Hospital, Busan
| | - Hyun Joon Hong
- Department of Otolaryngology, Catholic Kwandong University International St. Mary's Hospital, Incheon
| | - Kang-Dae Lee
- Department of Otolaryngology, Kosin University Gospel Hospital, Busan, Korea
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Abstract
Permanent hypoparathyroidism following thyroid surgery is rare. Its prevalence is reported to be below 1-2% if surgery is performed by experienced thyroid surgeons. Parathyroid identification and preservation in situ with good vascular supply is the mainstay of safe thyroid surgery. However, if the parathyroid glands are damaged, autotransplantation should be undertaken to preserve their function. Parathyroid transplantation can be considered in three distinct modes of application: (I) fresh parathyroid tissue autotransplantation during thyroidectomy in order to reduce the risk of permanent hypoparathyroidism; (II) cryopreserved parathyroid tissue autotransplantation in patients with permanent hypoparathyroidism; (III) parathyroid allotransplantation in patients with permanent hypoparathyroidism when cryopreserved parathyroid tissue is not available for grafting. Nowadays, allotransplantation of cultured parathyroid cells without immunosuppression should be taken into consideration in selected patients as an alternative to calcium and vitamin D3 supplementation in management of permanent hypoparathyroidism. This paper is aimed to provide a review of current status of various parathyroid transplantation techniques in thyroid surgery.
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Affiliation(s)
- Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Filip Gołkowski
- Department of Endocrinology and Internal Medicine, Andrzej Frycz Modrzewski Krakow University, Faculty of Medicine, Kraków, Poland
| | - Ireneusz Nawrot
- Department of General, Vascular and Transplantation Surgery, the Medical University of Warsaw, Warsaw, Poland
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58
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Su A, Wang B, Gong Y, Gong R, Li Z, Zhu J. Risk factors of hypoparathyroidism following total thyroidectomy with central lymph node dissection. Medicine (Baltimore) 2017; 96:e8162. [PMID: 28953664 PMCID: PMC5626307 DOI: 10.1097/md.0000000000008162] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The risk factors of hypoparathyroidism after total thyroidectomy (TT) with central lymph node dissection (CND) have not been completely defined. The aim of the study was to evaluate the risk factors of hypoparathyroidism after the surgery.We retrospectively reviewed our patients who underwent TT and CND (including lateral lymph node dissection) for thyroid carcinoma between January 2013 and June 2016. According to the postoperative serum levels of parathyroid hormone within 6 months, the patients were divided into normal, transient hypoparathyroidism, and permanent hypoparathyroidism groups. The clinicopathologic characteristics and surgical details were compared among the 3 groups. The risk factors of hypoparathyroidism were investigated by univariate and multivariate analyses.Of the 903 patients, 399 (44.2%) were found to have transient hypoparathyroidism and 10 (1.1%) had permanent hypoparathyroidism. On multivariate analysis, female gender (P < .001), nonuse of carbon nanoparticles (P = .038), parathyroid autotransplantation (P < .001), accidental parathyroid resection (P = .004), and bilateral CND (BCND, P = .003) were the independent risk factors of transient hypoparathyroidism; nonuse of carbon nanoparticles (P = .041) and a tumor in the upper pole of thyroid gland (P = .031) were the independent risk factors of permanent hypoparathyroidism. Patients with transient hypoparathyroidism were more likely to develop permanent hypoparathyroidism when they had hypertension (P = .026) and a tumor in the upper pole of thyroid gland (P = .010).Precise surgical techniques and carbon nanoparticles suspension should be applied for in situ preservation of parathyroid glands (PGs) in thyroid carcinoma patients, especially in females with hypertension and a tumor in the upper pole of thyroid gland. Autotransplantation is only performed when a PG is resected inadvertently or devascularized. TT with BCND should be better performed by an experienced surgeon to reduce the incidence of hypoparathyroidism.
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Giordano D, Frasoldati A, Gabrielli E, Pernice C, Zini M, Castellucci A, Piana S, Ciarrocchi A, Cavuto S, Barbieri V. Long-term outcomes of central neck dissection for cN0 papillary thyroid carcinoma. Am J Otolaryngol 2017; 38:576-581. [PMID: 28599790 DOI: 10.1016/j.amjoto.2017.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/18/2017] [Accepted: 06/04/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The risk-benefit ratio of central neck dissection (CND) in patients affected by papillary thyroid carcinoma (PTC) without clinical or ultrasonographic (US) evidence of neck lymph node metastasis (cN0) is currently debated. The aim of this study was to evaluate long-term outcome of CND on locoregional recurrence, distant metastasis, survival, and postoperative complications in a large series of patients with cN0-PTC. STUDY DESIGN Observational retrospective controlled study. METHODS Clinical records of patients (n=610) surgically treated for cN0-PTC at the Otolaryngology Unit of the Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy, from January 1984 to December 2008, were retrospectively reviewed. Study population was divided into three groups according to surgical treatment: Group A, total thyroidectomy (n=205); Group B, total thyroidectomy and elective ipsilateral CND (n=281); Group C, total thyroidectomy and bilateral CND (n=124). RESULTS Of a total of 610 patients, 305 (50%) were classified as low-risk, 278 (45.57%) as intermediate-risk, and 27 (4.43%) as high-risk. Response to initial therapy was excellent in 567 patients (92.95%), acceptable in 21 (3.44%), and incomplete in 22 (3.61%), with no significant differences among groups. Locoregional recurrence was detected in 32 (5.2%) out of 610 patients. Distant metastasis was found in 15 patients (2.5%). Statistical analysis showed no significant differences in the rates of locoregional recurrence (p=0.890) or distant metastasis (p=0.538) among groups. Disease-specific mortality and overall survival did not significantly differ among groups (p=0.248 and 0.223, respectively). Rate of permanent hypoparathyroidism was significantly higher in Group C patients compared to those in Groups A and B. CONCLUSION CND does not confer any clear advantage in the treatment of low-risk patients, regardless of surgical procedure. Instead, bilateral CND may be effective in limiting disease relapse and/or progression in patients at higher prognostic risk. Our data indicate that elective CND does not confer any clear advantage in terms of locoregional recurrence and long-term survival, as demonstrated by outcomes of the study Groups, regardless of their different prognostic risk. Elective CND allows a more accurate pathologic staging of central neck lymph nodes, despite its increasing the risk of permanent hypoparathyroidism. Intraoperative pathologic staging is a valuable tool to assess the risk of controlateral lymph node metastasis in the central neck compartment and to limit more aggressive surgery only to cases, otherwise understaged, with lymph node metastasis.
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60
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Ayşan E, Düzköylü Y, Can İ, Büyükpınarbaşılı N. Xenotransplantation of human cryopreserved parathyroid tissue isolated from parathyroid adenomas to normocalcemic rabbits. Turk J Surg 2017; 33:91-95. [PMID: 28740957 PMCID: PMC5508249 DOI: 10.5152/turkjsurg.2017.3427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/04/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Parathyroid allotransplantation is a new method for the treatment of permanent hypoparathyrodism. Adenoma cells are not used for transplantation because of the potential for functional or histopathologic transformation. In this study, we transplanted human adenomatous parathyroid cells to rabbits. MATERIAL AND METHODS Parathyroid adenoma tissue taken from a male patient was cryopreserved and transplanted into seven New Zealand white rabbits (mean weight, 3700±220 g; mean age, 4.5 months) under immunosuppression. The levels of parathormone, calcium and phosphorus were measured before and after transplantation, and the parathyroid cells were observed histopathologically. RESULTS Mean parathyroid hormone level was 0.5 pg/dL before transplantation and 6.6 pg/dL after transplantation (p<0.05). Preoperative mean calciumlevel was 14.1 mg/dL, and mean phosporus level was 3.5 mg/dL before transplantation while these values were 14.4 mg/dL and 3.3 mg/dL, respectively, after transplantation (p>0.05). Morphologic transformation was not observed in parathyroid cells after transplantation. CONCLUSION In short-term observation, adenomatous parathyroid cells can function without malignant transformation. In the future, the preliminary methodology in this study may serve as a safe alternative for allotransplantation into patients with permanent hypoparathyroidism.
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Affiliation(s)
- Erhan Ayşan
- Department of General Surgery, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Yiğit Düzköylü
- Department of General Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - İsmail Can
- Institute of Experimental Medicine, İstanbul University, İstanbul, Turkey
| | - Nur Büyükpınarbaşılı
- Department of Pathology, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
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61
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Fama' F, Sindoni A, Gioffre'-Florio M. Comment on Article Entitled "Parathyroid Autotransplantation During Thyroid Surgery: A Novel Technique Using a Cell Culture Nutrient Solution": Reply. World J Surg 2017; 41:1654-1655. [PMID: 28265734 DOI: 10.1007/s00268-017-3967-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Fausto Fama'
- Department of Human Pathology, University Hospital of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy.
| | - Alessandro Sindoni
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - Maria Gioffre'-Florio
- Department of Human Pathology, University Hospital of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
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Cavallaro G, Iorio O, Centanni M, Gargano L, Del Duca S, Gurrado A, Porta N, Petrozza V, Testini M, De Toma G. Parathyroid reimplantation with PR-FaST technique in unselected patients during thyroidectomy. A case series with long term follow up confirming graft vitality and parathormone production. Int J Surg 2017; 39:202-205. [PMID: 28167381 DOI: 10.1016/j.ijsu.2017.01.117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Parathyroid damage or unintentional excision still affect thyroid surgery and may cause permanent hypoparathyroidism. The only way to recover the excised or ischemic gland functionality is still reimplantation. Many sites of reimplantation have been described, each of one showing both advantages and drawbacks. The aim of this study is to verify results of a new procedure called PR-FaST: Parathyroid Reimplantation in Forearm Subcutaneous Tissue, in a series of unselected patients after long-term follow-up. MATERIALS AND METHODS From January 2013 to October 2015, 296 consecutive total thyroidectomies have been performed) to treat both benign and malignant thyroid diseases. in 42 cases (14.1%), due to an insufficient blood supply or accidental removal, one parathyroid gland was reimplanted with the PR-FaST technique. Post-operative evaluation was carried out by: total serum calcium (Ca), magnesium (Mg) and phosphorus (P) analysis in the 1st and 2nd postoperative days; Ca, Mg, P and serum iPTH from both arms analysis one week after surgery; Ca and iPTH measurement from both arms 1 months, 3, 6 and 12 months after surgery. RESULTS We observed transient hypocalcemia requiring calcium replacement therapy in 5 on 42 (11.9%) patients submitted to PR-FaST. No case of permanent hypoparathyroidism was reported. At 1 week after surgery, only 20 patients (47.6%) showed graft vitality, while the number of patients showing graft vitality arised to 33 (79%) after 1 month and to 39 (92.8%) after three and six months. At 1 year 38 (90.5%) patients showed good graft functionality. Considering levels of serum iPTH from both arms, we observed that in case of graft functionality, samples from reimplanted arm revealed in almost all cases values at least 2-3 folds higher than in non reimplanted arm. CONCLUSIONS Results from this prospective evaluation suggest that PR-FaST is a safe and effective procedure, with potential advantages when compared to other techniques of parathyroid reimplantation, that are mainly the possibility to evaluate graft functionality in the follow-up and the easy and well reproducible technique. Furthermore, it can be applied, when needed, to potentially all patients undergoing thyroidectomy.
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Affiliation(s)
| | - Olga Iorio
- Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
| | - Marco Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Lucilla Gargano
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Susanna Del Duca
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Angela Gurrado
- Department of Biomedical Sciences and Human Oncology, University of Bari, Italy
| | - Natale Porta
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Vincenzo Petrozza
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Mario Testini
- Department of Biomedical Sciences and Human Oncology, University of Bari, Italy
| | - Giorgio De Toma
- Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
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Lorente-Poch L, Sancho J, Muñoz JL, Gallego-Otaegui L, Martínez-Ruiz C, Sitges-Serra A. Failure of fragmented parathyroid gland autotransplantation to prevent permanent hypoparathyroidism after total thyroidectomy. Langenbecks Arch Surg 2017; 402:281-287. [PMID: 28064342 DOI: 10.1007/s00423-016-1548-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/26/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Parathyroid autotransplantation during total thyroidectomy leads to higher rates of postoperative hypocalcaemia. It has been argued, however, that it prevents permanent hypoparathyroidism. The impact of autografted normal parathyroid gland fragments on long-term parathyroid status has not been assessed properly. To clarify this, the short- and long-term parathyroid function was assessed in patients with three glands remaining in situ after total thyroidectomy, in whom the fourth gland was either autotransplanted (Tx) or accidentally resected (AR). METHODS Consecutive patients (n = 669) undergoing first-time total thyroidectomy were prospectively studied recording the number of parathyroid glands remaining in situ: PGRIS =4-(glands autografted + glands in the specimen). The study was focused on the subgroup of 186 patients with three parathyroid glands remaining in situ as a result of either accidental resection (AR, n = 76) or autotransplantation into the sternocleidomastoid muscle (Tx, n = 110). Prevalence of postoperative hypocalcaemia, protracted, and permanent hypoparathyroidism were compared between the two groups. Demographic, disease-related, laboratory, and surgical variables were recorded. All patients were followed for at least 1 year. RESULTS Both groups were comparable in terms of disease and extent of surgery. Mean postoperative serum calcium was the same (AR: 1.97 ± 0.2 vs Tx: 1.97 ± 0.22 mmol/L). Rates of protracted (AR: 24% vs Tx: 25.5%) and permanent hypoparathyroidism (AR: 5.3% vs Tx: 7.3%) were similar in both groups. CONCLUSIONS The prevalence of parathyroid failure syndromes after total thyroidectomy was similar whether a parathyroid gland was inadvertently excised or autotransplanted. Autotransplantation did not influence the permanent hypoparathyroidism rate.
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Affiliation(s)
- Leyre Lorente-Poch
- Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Juan Sancho
- Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Jose Luis Muñoz
- Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Lander Gallego-Otaegui
- Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Carlos Martínez-Ruiz
- Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Antonio Sitges-Serra
- Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
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64
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Jha C, Bichoo R, Yadav S. Comment on Article Entitled "Parathyroid Autotransplantation During Thyroid Surgery: A Novel Technique Using a Cell Culture Nutrient Solution". World J Surg 2017; 41:1652-1653. [PMID: 28058474 DOI: 10.1007/s00268-016-3862-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Chandan Jha
- Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India.
| | - Raouef Bichoo
- Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Sanjay Yadav
- Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
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65
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Famà F, Cicciù M, Polito F, Cascio A, Gioffré-Florio M, Piquard A, Saint-Marc O, Sindoni A. Parathyroid Autotransplantation During Thyroid Surgery: A Novel Technique Using a Cell Culture Nutrient Solution. World J Surg 2016; 41:457-463. [PMID: 27734084 DOI: 10.1007/s00268-016-3754-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Parathyroid autotransplantation is an easy procedure with a low complication rate. We adopted the transplantation into the sternocleidomastoid muscle, which allows an easier and time-saving surgical procedure using the same surgical incision. METHODS In this study, we retrospectively reviewed the records of 396 consecutive patients, who underwent total thyroidectomy for benign thyroid disease. In all cases in which a parathyroid was damaged or inadvertently removed, the gland was transplanted; before the autotransplantation, the parathyroid tissue was put in a cell culture nutrient solution for 5 min, afterward fragmented, and then was transplanted in the sternocleidomastoid muscle. To demonstrate a beneficial effect of the cell nutrient solution step, we compared data of transplanted patients with a control group of cases (n = 190) undergoing a standard immediate autotransplantation. RESULTS We divided patients in two main groups: group A (n = 160) including subjects that underwent one or more parathyroid gland autotransplantation using the cell nutrient solution, and group B (n = 236) concerning those who were not transplanted. Among patients, 62 hypocalcemias occurred, 40 in the group A and 22 in the group B (P < 0.001): 91.9 % were transient and 8.1 % (5 patients) definitive, all pertaining to the group B. Among controls (group C), 42 hypocalcemias occurred (P = 0.616 vs. group A and P = 0.002 vs. group B) and 3/42 became definitive (P = 0.096 vs. group A and P = 0.121 vs. group B). All differences concerning pre- and postoperative calcium values were statistically significant (P < 0.001). CONCLUSIONS We recommend the routine parathyroid autotransplantation, when a vascular damage is certain or suspected, in order to reduce the rate of permanent hypoparathyroidism, using a cell culture nutrient solution before gland transplantation.
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Affiliation(s)
- Fausto Famà
- Department of Human Pathology, University Hospital of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy. .,Complesso MITO, Residenza Ginestre F/2, 98151, Messina, Italy.
| | - Marco Cicciù
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - Francesca Polito
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - Antonio Cascio
- Department of Human Pathology, University Hospital of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - Maria Gioffré-Florio
- Department of Human Pathology, University Hospital of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - Arnaud Piquard
- Department of General, Endocrine and Thoracic Surgery, Regional Hospital of Orleans, 14, Avenue de l'Hopital, 45067, Orléans (cedex 2), France
| | - Olivier Saint-Marc
- Department of General, Endocrine and Thoracic Surgery, Regional Hospital of Orleans, 14, Avenue de l'Hopital, 45067, Orléans (cedex 2), France
| | - Alessandro Sindoni
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
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Kirdak T, Dundar HZ, Uysal E, Ocakoglu G, Korun N. Outcomes of Parathyroid Autotransplantation During Total Thyroidectomy: A Comparison with Age- and Sex-Matched Controls. J INVEST SURG 2016; 30:201-209. [PMID: 27700191 DOI: 10.1080/08941939.2016.1232768] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine the effect of parathyroid autotransplantation (PA) on postoperative hypocalcemia in cases of total thyroidectomy. MATERIALS AND METHODS Cases undergoing total thyroidectomy and PA were compared with age and sex-matched controls who had not undergone PA. The postoperative percentage changes (PC) of parathyroid hormone (PTH) and calcium (Ca+2) in the first 12-24 hours (12-24hr→preop), between the 1st-3rd weeks (1-3wk→preop) and at the 6th month (6mo→preop), the rates of hypocalcemia (Ca+2< 8mg/dL) and low PTH level (PTH< 15 pg/mL), permanent hypocalcemia, inadvertent parathyroidectomy in both groups were compared. RESULTS The number of patients with PTH12-24hr<15 pg/mL was significantly higher (n:34,(55.7%)) than the number of patients in the control group (n:16(26.2%)), (p=0.001). The rate of decrease in the blood Ca+2 median PC (6mo→preop) was significantly higher in the PA group (4.2%) than the control group (1.1%), (p=0.008). There was no significant difference between the 2 groups in terms of the postoperative frequency of hypocalcemia (p>0.05). In the PA&age≤50 group, the rate of inadvertent parathyroidectomy was higher than that of cases over age 50 (p=0.029). CONCLUSION In spite of the presence of an increased postoperative hypocalcemia trend in cases requiring PA during total thyroidectomy, the rates of transient and permanent hypocalcemia were not different to the control cases. But the frequency of cases with low PTH level in cases undergoing PA was higher than that of the control cases. In cases of 50 years of age and under, who had undergone PA, the possibility of inadvertent parathyroidectomy increased.
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Affiliation(s)
- Turkay Kirdak
- a Department of Surgery , Uludag University Faculty of Medicine , Bursa , Turkey
| | - Halit Ziya Dundar
- a Department of Surgery , Uludag University Faculty of Medicine , Bursa , Turkey
| | - Erdal Uysal
- b Department of Surgery , Sanko University School of Medicine , Gaziantep , Turkey
| | - Gokhan Ocakoglu
- c Department of Biostatistics , Uludag University Faculty of Medicine , Bursa , Turkey
| | - Nusret Korun
- a Department of Surgery , Uludag University Faculty of Medicine , Bursa , Turkey
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Hall CM, Snyder SK, Maldonado YM, Lairmore TC. Routine central lymph node dissection with total thyroidectomy for papillary thyroid cancer potentially minimizes level VI recurrence. Surgery 2016; 160:1049-1058. [DOI: 10.1016/j.surg.2016.06.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/09/2016] [Accepted: 06/23/2016] [Indexed: 12/16/2022]
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Touska P, Srikanthan A, Amarasinghe K, Jawad S. Parathyroid adenoma arising within the sternocleidomastoid muscle: a rare complication of autotransplantation. BMJ Case Rep 2016; 2016:bcr-2015-213184. [PMID: 27440844 DOI: 10.1136/bcr-2015-213184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
A 19-year-old patient presented with slowly enlarging, painless, left-sided cervical mass. She had a background of multiple endocrine neoplasia 2B and had undergone a total thyroidectomy for medullary thyroid carcinoma during childhood. A cervical recurrence was therefore suspected. Ultrasonographic and MRI examination revealed a well-defined lesion within the left sternocleidomastoid muscle. Further evaluation with sestamibi and single-photon emission CT revealed elevated tracer uptake within the lesion. Cytological analysis, following ultrasound-guided sampling, revealed absent staining for calcitonin and blood samples confirmed a normal serum calcitonin level; however, the serum parathyroid hormone level was elevated. Overall, summative findings were consistent with a diagnosis of a parathyroid adenoma arising within the left sternocleidomastoid muscle. Given that this is not a location for a physiological parathyroid tissue, the adenoma might have arisen within the autotransplanted parathyroid tissue, injected into the muscular sheath during thyroidectomy. The clinical, radiological and pathological features are considered in this article.
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Affiliation(s)
- Philip Touska
- Department of Radiology, St. George's Hospital NHS Trust, London, UK
| | - Ahgi Srikanthan
- Department of Radiology, St. George's Hospital NHS Trust, London, UK
| | - Kavita Amarasinghe
- Department of Cellular Pathology, St. George's Hospital NHS Trust, London, UK
| | - Susan Jawad
- Department of Radiology, St. George's Hospital NHS Trust, London, UK Department of Head & Neck Radiology, University College Hospital, London, UK
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Zhao Y, Luo B. Adipose-derived stem cells: A novel source of parathyroid cells for treatment of hypoparathyroidism. Med Hypotheses 2016; 93:143-5. [PMID: 27372875 DOI: 10.1016/j.mehy.2016.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 03/02/2016] [Accepted: 05/12/2016] [Indexed: 12/24/2022]
Abstract
Hypoparathyroidism is characterized by decreased function of the parathyroid glands with underproduction of parathyroid hormone (PTH), which can lead to low levels of calcium in the blood, often causing cramping and twitching of muscles or tetany, and several other symptoms. Severe hypocalcemia is a life-threatening condition. At present, both medical and surgical treatments are offered to improve the blood calcium, but they are not a cure. Adipose-derived stem cells (ADSCs), derived from the adipose tissue, are confirmed to be multipotent with adipogenic, chondrogenic, neurogenic, myogenic and osteogenic capabilities. Our hypothesis is that human ADSCs in culture can be differentiated into parathyroid cells, and used to reconstitute function.
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Affiliation(s)
- Yue Zhao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchunjie Street, Xuanwu District, Beijing, China
| | - Bin Luo
- Department of General Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University Medical Center, No. 168 Litang Road, Changping District, Beijing 102218, China.
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Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy. North Clin Istanb 2016; 3:9-14. [PMID: 28058379 PMCID: PMC5175085 DOI: 10.14744/nci.2016.48802] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/15/2016] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The present study evaluated effects of incidental parathyroidectomy, surgical technique, and presence of thyroiditis or hyperthyroidism on occurrence of postoperative persistent or transient hypocalcemia. METHODS Patients who underwent thyroidectomy at İstanbul Medeniyet University between 2013 and 2015 were included in the study. Patient information, postoperative serum calcium levels, and pathology reports were investigated retrospectively. Group 1 was made up of patients who were found to have hypocalcemia (calcium ≤8.5 mg/dL) according to postoperative serum level and normocalcemic patients were placed in Group 2. Groups were compared statistically in terms of rate of incidental parathyroidectomy, surgical technique, and presence of thyroiditis or hyperthyroidism. RESULTS Mean age was 49.8±12.8 years (range: 20-88). A total of 417 patients were included in the study, 74 (17.7%) were male and 343 (82.3%) were female. Group 1 consisted of 205 (49.2%) patients who had hypocalcemia according to postoperative serum level, and remaining 212 (50.8%) patients were placed in Group 2. In Group 1, 38 (18.5%) patients had incidental parathyroidectomy, and with only 18 (8.5%) patients in Group 2, a statistically significant relationship was found between incidental parathyroidectomy and hypocalcemia (p=0.003). There was no statistically significant difference in terms of presence of thyroiditis or hyperthyroidism between groups. There was statistically significant decrease in postoperative hypocalcemia rate in patients with lobectomy compared to patients with bilateral total thyroidectomy or central neck dissection (p<0.01). CONCLUSION Risk of postoperative hypocalcemia may be reduced with lobectomy for selected patients. In addition, delicate dissection during thyroidectomy is important in order to protect parathyroid glands and prevent hypocalcemia.
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Vidal Fortuny J, Belfontali V, Sadowski SM, Karenovics W, Guigard S, Triponez F. Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery. Br J Surg 2016; 103:537-43. [PMID: 26864909 PMCID: PMC5067567 DOI: 10.1002/bjs.10101] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 11/05/2015] [Accepted: 12/10/2015] [Indexed: 12/02/2022]
Abstract
BACKGROUND Postoperative hypoparathyroidism remains the most common complication following thyroidectomy. The aim of this pilot study was to evaluate the use of intraoperative parathyroid gland angiography in predicting normal parathyroid gland function after thyroid surgery. METHODS Angiography with the fluorescent dye indocyanine green (ICG) was performed in patients undergoing total thyroidectomy, to visualize vascularization of identified parathyroid glands. RESULTS Some 36 patients underwent ICG angiography during thyroidectomy. All patients received standard calcium and vitamin D supplementation. At least one well vascularized parathyroid gland was demonstrated by ICG angiography in 30 patients. All 30 patients had parathyroid hormone (PTH) levels in the normal range on postoperative day (POD) 1 and 10, and only one patient exhibited asymptomatic hypocalcaemia on POD 1. Mean(s.d.) PTH and calcium levels in these patients were 3·3(1·4) pmol/l and 2·27(0·10) mmol/l respectively on POD 1, and 4·0(1.6) pmol/l and 2·32(0·08) mmol/l on POD 10. Two of the six patients in whom no well vascularized parathyroid gland could be demonstrated developed transient hypoparathyroidism. None of the 36 patients presented symptomatic hypocalcaemia, and none received treatment for hypoparathyroidism. CONCLUSION PTH levels on POD 1 were normal in all patients who had at least one well vascularized parathyroid gland demonstrated during surgery by ICG angiography, and none required treatment for hypoparathyroidism.
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Affiliation(s)
- J. Vidal Fortuny
- Thoracic and Endocrine SurgeryUniversity Hospitals of Geneva, 4 Rue Gabrielle Perret‐Gentil, 1211GenevaSwitzerland
| | - V. Belfontali
- Thoracic and Endocrine SurgeryUniversity Hospitals of Geneva, 4 Rue Gabrielle Perret‐Gentil, 1211GenevaSwitzerland
| | - S. M. Sadowski
- Thoracic and Endocrine SurgeryUniversity Hospitals of Geneva, 4 Rue Gabrielle Perret‐Gentil, 1211GenevaSwitzerland
| | - W. Karenovics
- Thoracic and Endocrine SurgeryUniversity Hospitals of Geneva, 4 Rue Gabrielle Perret‐Gentil, 1211GenevaSwitzerland
| | - S. Guigard
- Thoracic and Endocrine SurgeryUniversity Hospitals of Geneva, 4 Rue Gabrielle Perret‐Gentil, 1211GenevaSwitzerland
| | - F. Triponez
- Thoracic and Endocrine SurgeryUniversity Hospitals of Geneva, 4 Rue Gabrielle Perret‐Gentil, 1211GenevaSwitzerland
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Järhult J, Landerholm K. Outcome of hypocalcaemia after thyroidectomy treated only in symptomatic patients. Br J Surg 2016; 103:676-683. [PMID: 26933938 DOI: 10.1002/bjs.10086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/28/2015] [Accepted: 11/20/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Calcium supplementation has been proposed after bilateral thyroid surgery, either to all patients or to those with biochemical hypocalcaemia. It has also been suggested that supplementation aids parathyroid recovery and prevents permanent hypoparathyroidism. This single-centre study investigated the feasibility of a restrictive management of post-thyroidectomy hypocalcaemia. METHODS Serum calcium was checked before surgery, on postoperative day 1 (POD) 1, at a follow-up visit 6-8 weeks after surgery and after a minimum of 12 months in all patients. Regardless of serum calcium levels, patients with symptoms of hypocalcaemia were prescribed oral calcium supplementation (0·5-1·0 g twice daily) and asymptomatic patients were not. Asymptomatic patients were informed about hypocalcaemic symptoms and instructed to contact the surgical ward should symptoms appear. RESULTS Some 640 patients underwent bilateral thyroid surgery without previous or intentional simultaneous parathyroidectomy. A subnormal serum calcium level (below 2·15 mmol/l) was observed in 412 patients (64·4 per cent) on POD 1. By comparison, only 63 patients (9·8 per cent) experienced symptoms of hypocalcaemia in the postoperative period, all but one with a corresponding biochemical hypocalcaemia on POD 1. Calcium levels in all patients with asymptomatic postoperative hypocalcaemia recovered to normal without supplementation. Serum calcium was also normalized during follow-up in all symptomatic patients, except 22 (3·4 per cent) who became permanently hypoparathyroid. No patient without early hypocalcaemic symptoms developed permanent hypoparathyroidism. CONCLUSION The proposed restrictive management of postoperative hypocalcaemia after bilateral thyroid surgery avoids unnecessary supplementation for most patients.
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Affiliation(s)
- J Järhult
- Department of Surgery, Ryhov County Hospital, SE-551 85, Jönköping, Sweden
| | - K Landerholm
- Department of Surgery, Ryhov County Hospital, SE-551 85, Jönköping, Sweden
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Cavallaro G, Iorio O, Centanni M, Porta N, Iossa A, Gargano L, Del Duca S, Gurrado A, Testini M, Petrozza V, Silecchia G. Parathyroid Reimplantation in Forearm Subcutaneous Tissue During Thyroidectomy: A Simple and Effective Way to Avoid Hypoparathyroidism. World J Surg 2016; 39:1936-42. [PMID: 25862025 DOI: 10.1007/s00268-015-3070-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Parathyroid autotransplantation plays an important role in preventing hypoparathyroidism following thyroidectomy. The preferred reimplantation site is still the sternocleidomastoid muscle, but this approach does not permit to check graft vitality postoperatively. The authors report the first prospective evaluation of normal parathyroid gland reimplantation in forearm subcutaneous tissue (using the same technique proposed during parathyroidectomy for hyperplasia) in case of devascularized or inadvertently removed glands during thyroid surgery. MATERIALS AND METHODS From January 2013 to August 2014, we performed 348 consecutive thyroidectomies for various disease, both benign and malignant. In 25 cases, due to inadvertent parathyroid removal or evidence of insufficient blood supply, we removed and fragmented the gland into 0.5-1 mm slices (one for frozen section) and reimplanted it into two subcutaneous pockets on the non-dominant forearm. After surgery we checked grafted gland function by evaluation of serum parathormone gradient between reimplanted versus non-reimplanted arm (considering significant a ratio of 1.5 or more), at 1 week, 1 and 3 months after surgery. RESULTS We observed recovery of reimplanted graft function in 48, 88 and 96% of patients respectively at 1 week, 1 and 3 months after surgery. All patients showed normal parathormone levels in peripheral blood (non-reimplanted arm). In one case we observed post-operative wound hematoma on graft-site. This patient showed no graft functionality in post-operative period (even at 3 months follow-up). CONCLUSIONS Parathyroid gland reimplantation in forearm subcutaneous tissue during thyroid surgery is a safe, easy and effective procedure; furthermore, it allows a good control of graft functionality and would allow an easy grafted gland removal if needed.
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Affiliation(s)
- Giuseppe Cavallaro
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, LT, Italy,
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Jin LX, Moley JF. Surgery for lymph node metastases of medullary thyroid carcinoma: A review. Cancer 2015; 122:358-66. [PMID: 26539937 DOI: 10.1002/cncr.29761] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 08/14/2015] [Accepted: 09/01/2015] [Indexed: 11/06/2022]
Abstract
Medullary thyroid carcinoma (MTC) is a neuroendocrine malignancy of the thyroid C cells that occurs in hereditary and sporadic clinical settings. Metastatic spread commonly occurs to cervical and mediastinal lymph nodes. MTC cells do not concentrate radioactive iodine and are not sensitive to hormonal manipulation, and therefore surgery is the most effective option for curative therapy, reduction in tumor burden, or effective palliation. In patients undergoing preventative surgery for hereditary MTC, central lymph node dissection should be considered if the calcitonin level is elevated. Preservation of parathyroid function in these young patients is of paramount importance. In patients with established primary tumors, systematic surgical removal of lymph node basins (compartmental dissection) should be guided by ultrasound mapping of lymph node metastases and level of serum calcitonin. A "berry-picking" approach is discouraged. Newly approved targeted molecular therapies offer wider treatment options for patients with progressive or metastatic disease.
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Affiliation(s)
- Linda X Jin
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jeffrey F Moley
- Section of Endocrine and Oncologic Surgery, Department of Surgery, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.,Department of Surgery, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri
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Jin LX, Moley JF. Surgery for lymph node metastases of medullary thyroid carcinoma. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2015. [DOI: 10.2217/ije.15.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Medullary thyroid carcinoma (MTC) is a neuroendocrine malignancy of the thyroid C cells, and can commonly spread to cervical and mediastinal lymph nodes. MTC cells do not concentrate radioactive iodine and are not sensitive to hormonal manipulation, and therefore surgery is the only effective option for curative therapy, reduction in tumor burden or effective palliation. In patients undergoing preventative operations for hereditary MTC, central lymph node dissection should be considered if the calcitonin level is above 40 pg/ml. Systematic removal of at-risk or involved lymph node compartments should be performed in all patients with palpable primary tumors and recurrent disease, and a ‘berry-picking’ approach should be avoided.
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Affiliation(s)
- Linda X Jin
- School of Medicine, Washington University in St Louis, 1 Brookings Dr., St Louis, MO 63130, USA
| | - Jeffrey F Moley
- Department of Surgery, Endocrine & Oncologic Surgery Section, Siteman Cancer Center, Washington University School of Medicine, 60 S Euclid Ave, St Louis, MO 63110, USA
- St. Louis Veteran's Affairs Medical Center, 1 Jefferson Barracks Rd, St Louis, MO 63125, USA
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Kim WW, Chung SH, Ban EJ, Lee CR, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS. Is Preoperative Vitamin D Deficiency a Risk Factor for Postoperative Symptomatic Hypocalcemia in Thyroid Cancer Patients Undergoing Total Thyroidectomy Plus Central Compartment Neck Dissection? Thyroid 2015; 25:911-8. [PMID: 26061175 DOI: 10.1089/thy.2014.0522] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although some studies have reported that preoperative vitamin D deficiency (VDD) is a risk factor for hypocalcemia after total thyroidectomy (TT) in patients with nontoxic multinodular goiter or Graves' disease, the association between VDD and postoperative hypocalcemia in thyroid cancer patients undergoing TT plus central compartment neck dissection (CCND) remains unclear. This study evaluated whether preoperative VDD was associated with postoperative symptomatic hypocalcemia. MATERIALS AND METHODS Data were collected prospectively between September 2012 and May 2013. A total of 267 consecutive thyroid cancer patients who underwent TT with CCND were analyzed. Patients were divided into two groups--VDD or non-VDD--by preoperative vitamin D level of <10 or ≥10 ng/mL. Symptomatic hypocalcemia was defined as serum calcium <8.2 mg/dL and symptoms or signs of hypocalcemia. The rates of postoperative symptomatic hypocalcemia and clinicopathological features were compared between the two patient groups. RESULTS The rate of postoperative symptomatic hypocalcemia was higher in the VDD group than in the non-VDD group (43.8% vs. 30.4%, p=0.043). By logistic regression analysis, predictive factors for postoperative symptomatic hypocalcemia included a preoperative vitamin D level of <10 ng/mL (p=0.007; odds ratio=3.00). In patients who had postoperative intact parathyroid hormone (iPTH) levels <15 pg/mL, symptomatic hypocalcemia was more common in the VDD group than in the non-VDD group (77.5% vs. 53.2%, p=0.008). The findings show that a preoperative vitamin D threshold level of >20 ng/mL reduced the risk of symptomatic hypocalcemia by 72% when compared with patients with VDD (p=0.003). CONCLUSION VDD is significantly associated with postoperative symptomatic hypocalcemia in thyroid cancer patients undergoing TT plus CCND. VDD was predictive for symptomatic hypocalcemia when patients had postoperative serum iPTH levels <15 pg/mL. Thus, preoperative supplementation with oral vitamin D should be considered to minimize postoperative symptomatic hypocalcemia.
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Affiliation(s)
- Won Woong Kim
- 1 Department of Surgery, Institute of Endocrine Research, Yonsei University Health System , Seoul, Korea
| | - So-Hyang Chung
- 2 Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul, Korea
| | - Eun Jeong Ban
- 1 Department of Surgery, Institute of Endocrine Research, Yonsei University Health System , Seoul, Korea
| | - Cho Rok Lee
- 1 Department of Surgery, Institute of Endocrine Research, Yonsei University Health System , Seoul, Korea
| | - Sang-Wook Kang
- 1 Department of Surgery, Institute of Endocrine Research, Yonsei University Health System , Seoul, Korea
| | - Jong Ju Jeong
- 1 Department of Surgery, Institute of Endocrine Research, Yonsei University Health System , Seoul, Korea
| | - Kee-Hyun Nam
- 1 Department of Surgery, Institute of Endocrine Research, Yonsei University Health System , Seoul, Korea
| | - Woong Youn Chung
- 1 Department of Surgery, Institute of Endocrine Research, Yonsei University Health System , Seoul, Korea
| | - Cheong Soo Park
- 1 Department of Surgery, Institute of Endocrine Research, Yonsei University Health System , Seoul, Korea
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Abd Elmaksoud AEM, Farahat IG, Kamel MM. Parathyroid gland autotransplantation after total thyroidectomy in surgical management of hypopharyngeal and laryngeal carcinomas: A case series. Ann Med Surg (Lond) 2015; 4:85-8. [PMID: 25852933 PMCID: PMC4381131 DOI: 10.1016/j.amsu.2014.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 11/11/2014] [Accepted: 11/15/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Total thyroidectomy is indicated in most cases with postcricoid carcinoma, circumferential hypopharyngeal carcinoma and in advanced laryngeal carcinoma. Persistent hypoparathyroidism is a frequent complication after total thyroidectomy which is difficult to manage unlike hypothyroidism. This study was to assess the feasibility of parathyroid gland autotranplantation after total thyroidectomy in advanced carcinomas and their effectiveness in preventing persistent hypoparathyroidism. METHODS This study included 26 patients with hypopharyngeal and laryngeal carcinoma presented to National Cancer Institute, Cairo University. Total thyroidectomy and total parathyroid gland excision were performed as a part of adequate oncologic surgical procedure. The parathyroid glands were identified, resected and stored in iced saline. Histological confirmation was necessary before implantation into separated muscle pockets in the anterior forearm muscles. Regular samples were drawn to assess serum parathormone and calcium levels. RESULTS All patients experienced hypocalcaemia within 1-5 days after operation. Only one patient experienced parathyroid graft failure while the remaining patients were normocalcemic during follow up after surgery, indicating functioning parathyroid grafts. CONCLUSIONS Parathyroid gland autotranplantation is a simple safe technique with high success rate in preventing persistent hypoparathyroidism after total thyroidectomy in surgical management of advanced hypopharyngeal and laryngeal carcinomas.
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Affiliation(s)
| | - Iman G. Farahat
- Department of Surgical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mahmoud M. Kamel
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
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Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, Lee N, Machens A, Moley JF, Pacini F, Raue F, Frank-Raue K, Robinson B, Rosenthal MS, Santoro M, Schlumberger M, Shah M, Waguespack SG. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid 2015; 25:567-610. [PMID: 25810047 PMCID: PMC4490627 DOI: 10.1089/thy.2014.0335] [Citation(s) in RCA: 1289] [Impact Index Per Article: 143.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The American Thyroid Association appointed a Task Force of experts to revise the original Medullary Thyroid Carcinoma: Management Guidelines of the American Thyroid Association. METHODS The Task Force identified relevant articles using a systematic PubMed search, supplemented with additional published materials, and then created evidence-based recommendations, which were set in categories using criteria adapted from the United States Preventive Services Task Force Agency for Healthcare Research and Quality. The original guidelines provided abundant source material and an excellent organizational structure that served as the basis for the current revised document. RESULTS The revised guidelines are focused primarily on the diagnosis and treatment of patients with sporadic medullary thyroid carcinoma (MTC) and hereditary MTC. CONCLUSIONS The Task Force developed 67 evidence-based recommendations to assist clinicians in the care of patients with MTC. The Task Force considers the recommendations to represent current, rational, and optimal medical practice.
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Affiliation(s)
- Samuel A. Wells
- Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sylvia L. Asa
- Department of Pathology, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Henning Dralle
- Department of General, Visceral, and Vascular Surgery, University Hospital, University of Halle-Wittenberg, Halle/Saale, Germany
| | - Rossella Elisei
- Department of Endocrinology, University of Pisa, Pisa, Italy
| | - Douglas B. Evans
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert F. Gagel
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andreas Machens
- Department of General, Visceral, and Vascular Surgery, University Hospital, University of Halle-Wittenberg, Halle/Saale, Germany
| | - Jeffrey F. Moley
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Furio Pacini
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Friedhelm Raue
- Endocrine Practice, Moleculargenetic Laboratory, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Karin Frank-Raue
- Endocrine Practice, Moleculargenetic Laboratory, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Bruce Robinson
- University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - M. Sara Rosenthal
- Departments of Internal Medicine, Pediatrics and Behavioral Science, University of Kentucky, Lexington, Kentucky
| | - Massimo Santoro
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Universita' di Napoli “Federico II,” Napoli, Italy
| | - Martin Schlumberger
- Institut Gustave Roussy, Service de Medecine Nucleaire, Université of Paris-Sud, Villejuif, France
| | - Manisha Shah
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Steven G. Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Risk Factors for Re-recurrence After First Reoperative Surgery for Locoregional Recurrent/Persistent Papillary Thyroid Carcinoma. World J Surg 2015; 39:1943-50. [DOI: 10.1007/s00268-015-3052-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wang B, Qiu NC, Zhang W, Shan CX, Jiang ZG, Liu S, Qiu M. The role of carbon nanoparticles in identifying lymph nodes and preserving parathyroid in total endoscopic surgery of thyroid carcinoma. Surg Endosc 2015; 29:2914-20. [PMID: 25761552 DOI: 10.1007/s00464-014-4020-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/25/2014] [Indexed: 11/25/2022]
Abstract
AIM To evaluate the efficacy of carbon nanoparticles (CNs) in identifying lymph nodes and preserving parathyroids in endoscopic total thyroidectomy (ETT) with central neck dissection (CND), and to further explore the role of CNs in recovering postoperative parathyroid function. METHOD Fifty-five patients with papillary thyroid carcinoma were randomized to either CN group (n = 28) or control group (n = 27). The primary outcome measures were pathological results (e.g., amount of incidental removed parathyroids and lymph nodes dissected) and follow-up results [e.g., recovery of serum calcium and parathyroid hormone (PTH) levels]. The secondary end-points were the rates of neuromuscular symptoms, in-hospital postoperative hormonal assay, and lymph node metastases. RESULTS A total of 193 lymph nodes in the CN group and 123 lymph nodes in the control group were detected. The mean number of detected lymph nodes was significantly higher in the CN group than in the control group (P = 0.009). Parathyroids were present in the thyroid or central nodal specimens of five patients, which were all in the control group. The control group had a relatively higher incidence of incidental parathyroidectomy compared to the CN group (P = 0.023). Compared to the CN group, the incidence of paresthesia was higher in the control group even if not statistically significant. During follow-up, the serum calcium levels were higher in the CN group than in the control group; however, there was no statistically significant difference. For the serum PTH levels, the CN group recovered rapidly to the preoperative levels, whereas the control group climbed steadily to the normal range. The serum PTH levels in the CN group were apparently higher than in the control group at 1 week and 1 month postoperatively. CONCLUSION CNs play an important role in protecting parathyroid glands, dissecting lymph nodes thoroughly, and promoting rapid recovery of parathyroid in ETT with CND (ChiCTR-TRC-14005042).
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Affiliation(s)
- Bin Wang
- Department of General Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, China.
| | - Nian-cun Qiu
- Department of General Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Wei Zhang
- Department of General Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Cheng-xiang Shan
- Department of General Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Zhi-guo Jiang
- Department of General Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Sheng Liu
- Department of General Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, China.
| | - Ming Qiu
- Department of General Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, China.
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Lorente-Poch L, Sancho JJ, Muñoz-Nova JL, Sánchez-Velázquez P, Sitges-Serra A. Defining the syndromes of parathyroid failure after total thyroidectomy. Gland Surg 2015; 4:82-90. [PMID: 25713783 DOI: 10.3978/j.issn.2227-684x.2014.12.04] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/23/2014] [Indexed: 11/14/2022]
Abstract
Acute and chronic parathyroid insufficiency syndromes are the most common complication after total thyroidectomy. Permanent hypoparathyroidism imposes an important medical burden on patient lifestyle due to the need for lifetime medication, regular visits and significant long-term costs. Its true prevalence has been underestimated due to lack of clear definitions, inadequate follow-up and conflicts of interest when reporting individual patient series. The aim of this review is to propose precise definitions for the different syndromes associated to parathyroid failure based on the follow-up and management of patients developing hypocalcemia (<8 mg/dL at 24 hours) after first-time total thyroidectomy for cancer or goiter at our unit. Short and long-term post-thyroidectomy parathyroid failure presents as three different metabolic syndromes: (I) postoperative hypocalcemia is defined as a s-Ca <8 mg/dL (<2 mmol/L) within 24 hours after surgery requiring calcium/vit D replacement therapy at the time of hospital discharge; (II) protracted hypoparathyroidism as a subnormal iPTH concentration (<13 pg/mL) and/or need for calcium/vit D replacement at 4-6 weeks; and (III) permanent hypoparathyroidism as a subnormal iPTH concentration (<13 pg/mL) and/or need for calcium/vit D replacement 1 year after total thyroidectomy. Each of these syndromes has its own pattern of recovery and should be approached with different therapeutic strategies.
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Affiliation(s)
- Leyre Lorente-Poch
- 1 Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain ; 2 Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain ; 3 General and Digestive Surgery Department, Hospital de la Princesa, Madrid, Spain
| | - Juan J Sancho
- 1 Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain ; 2 Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain ; 3 General and Digestive Surgery Department, Hospital de la Princesa, Madrid, Spain
| | - Jose Luis Muñoz-Nova
- 1 Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain ; 2 Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain ; 3 General and Digestive Surgery Department, Hospital de la Princesa, Madrid, Spain
| | - Patricia Sánchez-Velázquez
- 1 Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain ; 2 Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain ; 3 General and Digestive Surgery Department, Hospital de la Princesa, Madrid, Spain
| | - Antonio Sitges-Serra
- 1 Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain ; 2 Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain ; 3 General and Digestive Surgery Department, Hospital de la Princesa, Madrid, Spain
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Fukui S, Endo Y, Hirayama K, Taniyama H, Kadosawa T. Identification and preservation of the parathyroid gland during total thyroidectomy in dogs with bilateral thyroid carcinoma: a report of six cases. J Vet Med Sci 2015; 77:747-51. [PMID: 25716481 PMCID: PMC4488417 DOI: 10.1292/jvms.13-0488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Simultaneous removal of bilateral thyroid tumors was performed while preserving the
parathyroid gland in six dogs. At least one external parathyroid gland was identified in
all dogs. In five cases, the external parathyroid gland and its blood supply were
preserved intact. In one dog, the vessels supplying the external parathyroid gland had
been invaded by the tumor, and the gland was thus removed and reimplanted into the
sternohyoid muscle. That dog required postoperative treatment with oral calcium gluconate
and vitamin D3. Local tumor recurrence was not observed in any of the cases.
The mean survival time was 920 days. We found that the external parathyroid gland could be
identified and preserved in most dogs undergoing total thyroidectomy.
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Affiliation(s)
- Sho Fukui
- School of Veterinary Medicine, Rakuno Gakuen University, 582 Bunkyodai Midorimachi, Ebetsu, Hokkaido 069-8501, Japan
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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; 102:359-67. [DOI: 10.1002/bjs.9676] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/10/2014] [Accepted: 09/19/2014] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Parathyroid failure is the most common complication after total thyroidectomy but factors involved are not completely understood. Accidental parathyroidectomy and parathyroid autotransplantation resulting in fewer than four parathyroid glands remaining in situ, and intensity of medical treatment of postoperative hypocalcaemia may have relevant roles. The aim of this study was to determine the relationship between the number of parathyroid glands remaining in situ and parathyroid failure after total thyroidectomy.
Methods
Consecutive patients undergoing first-time total thyroidectomy were studied prospectively, recording the number of Parathyroid Glands Remaining In Situ (PGRIS = 4 − (glands autografted + glands in the specimen)) and the occurrence of postoperative hypocalcaemia, and protracted and permanent hypoparathyroidism. Demographic, disease-related, laboratory and surgical variables were recorded. Patients were classified according to the PGRIS number into group 1–2 (one or two PGRIS), group 3 (three PGRIS) and group 4 (all four glands remaining in situ), and were followed for at least 1 year.
Results
A total of 657 patients were included, 43 in PGRIS group 1–2, 186 in group 3 and 428 in group 4. The prevalence of hypocalcaemia, and of protracted and permanent hypoparathyroidism was inversely related to the PGRIS score (group 1–2: 74, 44 and 16 per cent respectively; group 3: 51·1, 24·7 and 6·5 per cent; group 4: 35·3, 13·1 and 2·6 per cent; P < 0·001). Intact parathyroid hormone concentrations at 24 h and 1 month were inversely correlated with PGRIS score (P < 0·001). Logistic regression identified PGRIS score as the most powerful variable influencing acute and chronic parathyroid failure. In addition, a normal–high serum calcium concentration 1 month after thyroidectomy influenced positively the recovery rate from protracted hypoparathyroidism in all PGRIS categories.
Conclusion
In situ parathyroid preservation is critical in preventing permanent hypoparathyroidism after total thyroidectomy. Active medical treatment of postoperative hypocalcaemia has a positive synergistic effect.
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Affiliation(s)
- L Lorente-Poch
- Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J J Sancho
- Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Ruiz
- Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain
| | - A Sitges-Serra
- Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
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Wei T, Li Z, Jin J, Chen R, Gong Y, Du Z, Gong R, Zhu J. Autotransplantation of Inferior Parathyroid glands during central neck dissection for papillary thyroid carcinoma: a retrospective cohort study. Int J Surg 2014; 12:1286-90. [PMID: 25448646 DOI: 10.1016/j.ijsu.2014.11.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 10/27/2014] [Accepted: 11/01/2014] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The management of inferior parathyroid glands during central neck dissection (CND) for papillary thyroid carcinoma (PTC) remains controversial. Most surgeons preserve inferior parathyroid glands in situ. Autotransplantation is not routinely performed unless devascularization or inadvertent parathyroidectomy occurs. This retrospective study aimed to compare the incidence of postoperative hypoparathyroidism and central neck lymph node (CNLN) recurrence in patients with PTC who underwent inferior parathyroid glands autotransplantation vs preservation in situ. METHODS This is a retrospective study which was conducted in a tertiary referral hospital. A total of 477 patients with PTC (pN1) who underwent total thyroidectomy (TT) and bilateral CND with/without lateral neck dissection were included. Patients' demographical characteristics, tumor stage, incidence of hypoparathyroidism, CNLN recurrence and the number of resected CNLN were analyzed. RESULTS Three hundred and twenty-one patients underwent inferior parathyroid glands autotransplantation (autotransplantation group). Inferior parathyroid glands were preserved in situ among 156 patients (preservation group). Permanent hypoparathyroidism rate was 0.9% (3/321) versus 3.8% (6/156) respectively (p = 0.028). Mean numbers of resected CNLN were 15 ± 3 (6-23) (autotransplantation group) versus 11 ± 3 (7-21) (preservation group) (p < 0.001). CNLN recurrence rate was 0.3% (1/321) versus 3.8% (6/156) respectively (p = 0.003). CONCLUSION Inferior parathyroid glands autotransplantation during CND of PTC (pN1) might reduce permanent hypoparathyroidism and CNLN recurrence. Further study enrolling more patients with long-term follow-up is needed to support this conclusion.
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Affiliation(s)
- Tao Wei
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR. China
| | - Zhihui Li
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR. China
| | - Judy Jin
- Department of Endocrine Surgery, Endocrine & Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rui Chen
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR. China
| | - Yanping Gong
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR. China
| | - Zhenhong Du
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR. China
| | - Rixiang Gong
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR. China
| | - Jingqiang Zhu
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR. China.
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Maia AL, Siqueira DR, Kulcsar MAV, Tincani AJ, Mazeto GMFS, Maciel LMZ. Diagnóstico, tratamento e seguimento do carcinoma medular de tireoide: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia. ACTA ACUST UNITED AC 2014; 58:667-700. [DOI: 10.1590/0004-2730000003427] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/12/2014] [Indexed: 12/20/2022]
Abstract
Introdução O carcinoma medular de tireoide (CMT) origina-se das células parafoliculares da tireoide e corresponde a 3-4% das neoplasias malignas da glândula. Aproximadamente 25% dos casos de CMT são hereditários e decorrentes de mutações ativadoras no proto-oncogene RET (REarranged during Transfection). O CMT é uma neoplasia de curso indolente, com taxas de sobrevida dependentes do estádio tumoral ao diagnóstico. Este artigo descreve diretrizes baseadas em evidências clínicas para o diagnóstico, tratamento e seguimento do CMT. Objetivo O presente consenso, elaborado por especialistas brasileiros e patrocinado pelo Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia, visa abordar o diagnóstico, tratamento e seguimento dos pacientes com CMT, de acordo com as evidências mais recentes da literatura. Materiais e métodos: Após estruturação das questões clínicas, foi realizada busca das evidências disponíveis na literatura, inicialmente na base de dados do MedLine-PubMed e posteriormente nas bases Embase e SciELO – Lilacs. A força das evidências, avaliada pelo sistema de classificação de Oxford, foi estabelecida a partir do desenho de estudo utilizado, considerando-se a melhor evidência disponível para cada questão. Resultados Foram definidas 11 questões sobre o diagnóstico, 8 sobre o tratamento cirúrgico e 13 questões abordando o seguimento do CMT, totalizando 32 recomendações. Como um todo, o artigo aborda o diagnóstico clínico e molecular, o tratamento cirúrgico inicial, o manejo pós-operatório e as opções terapêuticas para a doença metastática. Conclusões O diagnóstico de CMT deve ser suspeitado na presença de nódulo tireoidiano e história familiar de CMT e/ou associação com feocromocitoma, hiperparatireoidismo e/ou fenótipo sindrômico característico, como ganglioneuromatose e habitus marfanoides. A punção aspirativa por agulha fina do nódulo, a dosagem de calcitonina sérica e o exame anatomopatológico podem contribuir na confirmação do diagnóstico. A cirurgia é o único tratamento que oferece a possibilidade de cura. As opções de tratamento da doença metastática ainda são limitadas e restritas ao controle da doença. Uma avaliação pós-cirúrgica criteriosa para a identificação de doença residual ou recorrente é fundamental para definir o seguimento e a conduta terapêutica subsequente.
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Development of hypoparathyroidism animal model and the feasibility of small intestinal submucosa application on the parathyroid autotransplantation. Eur Arch Otorhinolaryngol 2014; 272:2969-77. [DOI: 10.1007/s00405-014-3262-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/28/2014] [Indexed: 01/08/2023]
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Lee YS, Chang HS, Chung WY, Nam KH, Park CS. Relationship between onset of hypocalcemic symptoms and the recovery time from transient hypocalcemia after total thyroidectomy. Head Neck 2014; 36:1732-6. [DOI: 10.1002/hed.23530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yong Sang Lee
- Department of Surgery; Institute of Endocrine Research, Yonsei University College of Medicine; Seoul Korea
| | - Hang-Seok Chang
- Department of Surgery; Institute of Endocrine Research, Yonsei University College of Medicine; Seoul Korea
| | - Woong Youn Chung
- Department of Surgery; Institute of Endocrine Research, Yonsei University College of Medicine; Seoul Korea
| | - Kee-Hyun Nam
- Department of Surgery; Institute of Endocrine Research, Yonsei University College of Medicine; Seoul Korea
| | - Cheong Soo Park
- Department of Surgery; Institute of Endocrine Research, Yonsei University College of Medicine; Seoul Korea
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Abstract
Thyroid cancer has been increasing in incidence, with the number of reported cases in the US rising by 25% over the last 3 years. With growing technological advances in the field and improved contributions of diagnostics, surgical decision-making and operative planning have taken on new challenges. Herein, we review the current clinical practice recommendations and active areas of surgical controversy, reflective of the most recently published professional consensus guidelines and a systematic review of the literature.
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Ban EJ, Yoo JY, Kim WW, Son HY, Park S, Lee SH, Lee CR, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS. Surgical complications after robotic thyroidectomy for thyroid carcinoma: a single center experience with 3,000 patients. Surg Endosc 2014; 28:2555-63. [DOI: 10.1007/s00464-014-3502-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 02/17/2014] [Indexed: 11/29/2022]
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90
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Kalyoncu D, Gönüllü D, Gedik ML, Er M, Kuroğlu E, İğdem AA, Koksoy FN. Analysis of the factors that have an effect on hypocalcemia following thyroidectomy. ULUSAL CERRAHI DERGISI 2013; 29:171-6. [PMID: 25931872 DOI: 10.5152/ucd.2013.2438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 11/22/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The incidence of and risk factors for hypocalcemia following thyroidectomy were evaluated in this study. MATERIAL AND METHODS One hundred and ninety thyroidectomy patients were evaluated retrospectively for factors that might contribute to postoperative hypocalcemia; age, hyperthyroidism, malignancy, the extent of surgery (total/near total/subtotal thyroidectomy), cervical lymph node dissection, and incidental parathyroidectomy. RESULTS The rate of transient hypocalcemia/hypoparathyroidism was 19.47%, with a permanent hypoparathyroidism rate of 4.74%. Factors affecting the development of transient hypocalcemia were found as being operated for hyperthyroidism, and use of total thyroidectomy as the surgical method. Total thyroidectomy increased the risk of postoperative hypocalcemia by 3.16 fold. Patients undergoing operations for hyperthyroidism had a 2.3 fold increase, and those undergoing total thyroidectomy had a 3.16 fold risk of postoperative hypocalcemia. CONCLUSION Hyperthyroidism surgery and total thyroidectomy lead to a higher risk of developing early postoperative or transient hypocalcemia. According to our results, no significant relationship could be established between any of the study parameters and persistent hypocalcemia.
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Affiliation(s)
- Doğa Kalyoncu
- Department of General Surgery, Burhan Nalbantoğlu State Hospital, Nicosia, Northern Cyprus Turkish Republic
| | - Doğan Gönüllü
- Department of General Surgery, Gaziosmanpaşa Taksim Teaching and Training Hospital, İstanbul, Turkey
| | - Mehmet Lari Gedik
- Department of General Surgery, Gaziosmanpaşa Taksim Teaching and Training Hospital, İstanbul, Turkey
| | - Muzaffer Er
- Department of General Surgery, Gaziosmanpaşa Taksim Teaching and Training Hospital, İstanbul, Turkey
| | - Erol Kuroğlu
- Department of General Surgery, Gaziosmanpaşa Taksim Teaching and Training Hospital, İstanbul, Turkey
| | - Ayşenur A İğdem
- Department of Pathology, Gaziosmanpaşa Taksim Teaching and Training Hospital, İstanbul, Turkey
| | - Ferda Nihat Koksoy
- Department of General Surgery, Gaziosmanpaşa Taksim Teaching and Training Hospital, İstanbul, Turkey
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Huang K, Luo D, Huang M, Long M, Peng X, Li H. Protection of parathyroid function using carbon nanoparticles during thyroid surgery. Otolaryngol Head Neck Surg 2013; 149:845-50. [PMID: 24163324 DOI: 10.1177/0194599813509779] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the hypothesis that injected carbon nanoparticle (CN) suspension helps identify parathyroid glands (PGs) during thyroid cancer surgery, thereby reducing PG injury. STUDY DESIGN A prospective, randomized controlled trial. Setting Sun Yet-san Memorial Hospital, Guangzhou, China. SUBJECTS AND METHODS Thyroid cancer surgeries were performed on 72 consenting patients who were randomized for conventional surgery (control group) or surgery with CN suspension injection (CN group). The primary end point was the prevalence of symptomatic hypocalcemia and serum calcium levels <1.9 mmol/L. RESULTS From 36 patients diagnosed with thyroid cancer in each group, symptomatic hypocalcemia was found in 10 patients without CN injection and 3 patients with CN suspension injection (P = .032). In total, 5.6% of patients in the CN group presented with muscle cramps compared with 22.2% of the control group (P = .041), which showed a significant difference. CONCLUSION Our randomized study revealed that CN suspension injection was feasible and appeared to be beneficial for patients undergoing thyroid surgery because the incidence of symptomatic hypocalcemia was lower compared with controls. Therefore, this technology and technique should be more widely considered for thyroid cancer therapy. Additional studies with more patients and longer follow-up times will be needed for a thorough evaluation of this methodology.
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Affiliation(s)
- Kai Huang
- Department of Thyroid and Vascular Surgery, Sun Yet-san Memorial Hospital, China
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Genser L, Trésallet C, Godiris-Petit G, Li Sun Fui S, Salepcioglu H, Royer C, Menegaux F. Randomized controlled trial of alfacalcidol supplementation for the reduction of hypocalcemia after total thyroidectomy. Am J Surg 2013; 207:39-45. [PMID: 24119718 DOI: 10.1016/j.amjsurg.2013.05.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 05/17/2013] [Accepted: 05/30/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the effect of perioperative alfacalcidol on postoperative hypocalcemia after total thyroidectomy. METHODS A total of 219 patients scheduled for total thyroidectomy were randomized into groups not receiving (group A) or receiving (group B) perioperative alfacalcidol. Postoperative hypocalcemia was compared between groups on postoperative day (POD) 1 and POD2. Patients with hypocalcemia (<2.00 mmol/L) received oral calcium supplementation. Calcium and vitamin D levels were measured at 5-week and 6-month follow-ups. RESULTS The incidence of symptomatic hypocalcemia was significantly lower in group A (P = .02), whereas similarly low levels of calcemia were observed in both groups on POD1 (37% and 30%, respectively; P = not significant) and persisted on POD2 (14% and 6%, respectively; P = not significant). Patients with severe hypocalcemia (<1.90 mmol/L) showed faster recovery in group A compared with group B (6% vs 1%, P = .04). At 5 weeks, calcium and vitamin D levels were similar between the groups. Six months after surgery, 4% (group A) versus 0% (group B) of subjects exhibited permanent hypoparathyroidism (P = .04). CONCLUSIONS Although the treatment did not correct vitamin D deficiency, perioperative alfacalcidol uptake resulted in decreased transient hypocalcemia and related symptoms in patients undergoing total thyroidectomy.
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Affiliation(s)
- Laurent Genser
- Department of General, Visceral & Endocrine Surgery, Pitié-Salpêtrière Hospital, Pierre et Marie Curie University (Paris VI), Assistance Publique, Hôpitaux de Paris, 83 Boulevard de l'hôpital, 75013 Paris, Paris 6 University, Paris, France
| | - Christophe Trésallet
- Department of General, Visceral & Endocrine Surgery, Pitié-Salpêtrière Hospital, Pierre et Marie Curie University (Paris VI), Assistance Publique, Hôpitaux de Paris, 83 Boulevard de l'hôpital, 75013 Paris, Paris 6 University, Paris, France
| | - Gaëlle Godiris-Petit
- Department of General, Visceral & Endocrine Surgery, Pitié-Salpêtrière Hospital, Pierre et Marie Curie University (Paris VI), Assistance Publique, Hôpitaux de Paris, 83 Boulevard de l'hôpital, 75013 Paris, Paris 6 University, Paris, France
| | - Stéphanie Li Sun Fui
- Department of General, Visceral & Endocrine Surgery, Pitié-Salpêtrière Hospital, Pierre et Marie Curie University (Paris VI), Assistance Publique, Hôpitaux de Paris, 83 Boulevard de l'hôpital, 75013 Paris, Paris 6 University, Paris, France
| | - Harika Salepcioglu
- Department of General, Visceral & Endocrine Surgery, Pitié-Salpêtrière Hospital, Pierre et Marie Curie University (Paris VI), Assistance Publique, Hôpitaux de Paris, 83 Boulevard de l'hôpital, 75013 Paris, Paris 6 University, Paris, France
| | - Catherine Royer
- Department of Anaesthesiology, Pitié-Salpêtrière Hospital, Pierre et Marie Curie University (Paris VI), Assistance Publique, Hôpitaux de Paris, Paris, France
| | - Fabrice Menegaux
- Department of General, Visceral & Endocrine Surgery, Pitié-Salpêtrière Hospital, Pierre et Marie Curie University (Paris VI), Assistance Publique, Hôpitaux de Paris, 83 Boulevard de l'hôpital, 75013 Paris, Paris 6 University, Paris, France.
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93
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Bai JB, Shakerian R, Westcott JD, Lichtenstein M, Miller JA. Factors influencing radioiodine uptake after thyroid cancer surgery. ANZ J Surg 2013; 85:572-7. [DOI: 10.1111/ans.12368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jia Bin Bai
- Department of Surgery; University of Melbourne; Parkville Victoria Australia
| | - Rezvaneh Shakerian
- Department of Surgery; Royal Melbourne Hospital; Parkville Victoria Australia
| | - James David Westcott
- Department of Nuclear Medicine; Royal Melbourne Hospital; Parkville Victoria Australia
| | - Meir Lichtenstein
- Department of Nuclear Medicine; Royal Melbourne Hospital; Parkville Victoria Australia
| | - Julie A. Miller
- Department of Surgery; University of Melbourne; Parkville Victoria Australia
- Department of Surgery; Royal Melbourne Hospital; Parkville Victoria Australia
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94
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Julián MT, Balibrea JM, Granada ML, Moreno P, Alastrué A, Puig-Domingo M, Lucas A. Intact parathyroid hormone measurement at 24 hours after thyroid surgery as predictor of parathyroid function at long term. Am J Surg 2013; 206:783-9. [PMID: 23835208 DOI: 10.1016/j.amjsurg.2013.01.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 08/20/2012] [Accepted: 01/04/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is no consensus about the usefulness of postoperative intact parathyroid hormone (iPTH) determination to predict permanent hypoparathyroidism (pHPP). We evaluated the value of calcium (Ca2+) and iPTH concentration at 24 hours after total thyroidectomy (TT) for predicting pHPP. METHODS Ca2+ and iPTH levels from 70 consecutive patients who underwent TT were measured at 24 hours and 6 months after TT. RESULTS Five patients (7.1%) developed pHPP. An iPTH concentration ≤5.8 pg/mL at 24 hours after TT identified patients at risk for pHPP (sensitivity, 100%; specificity, 81.5%), but it was not accurate enough to predict its development (positive predictive value, 30%). Conversely, an iPTH level >5.8 pg/mL predicted normal parathyroid function at 6 months (negative predictive value, 100%). Compared with iPTH, a postoperative Ca2+ level ≤1.95 mmol/L was 60% sensitive and 78.5% specific to predict pHPP. CONCLUSIONS An iPTH concentration >5.8 pg/mL on the first postoperative day rules out pHPP with much better diagnostic accuracy than Ca2+. Postoperative iPTH could be helpful in identifying patients at risk for developing pHPP.
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Affiliation(s)
- María Teresa Julián
- Endocrinology and Nutrition Service, Germans Trias i Pujol University Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
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95
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Larrad Jiménez Á, Hernández Hernández JR. Autotrasplante de paratiroides. ACTA ACUST UNITED AC 2013; 60:161-3. [DOI: 10.1016/j.endonu.2012.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 10/30/2012] [Accepted: 11/03/2012] [Indexed: 11/15/2022]
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96
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Bhargav PRK. Salient anatomical landmarks of thyroid and their practical significance in thyroid surgery: a pictorial review of thyroid surgical anatomy (revisited). Indian J Surg 2013; 76:207-11. [PMID: 25177118 DOI: 10.1007/s12262-013-0856-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 01/16/2013] [Indexed: 10/27/2022] Open
Abstract
Thyroid surgery is a prototype of operations requiring thorough knowledge of surgical anatomy. There are many vital and delicate anatomical structures such as recurrent laryngeal nerve, superior laryngeal nerve, parathyroid glands, and distinct fascial planes surrounding the thyroid gland. A protean range of pathologies such as goiter, nodules, thyroiditis, and malignancy distort or alter the location and course of these structures and planes. The distinct vascular supply and high vascularity of thyroid region challenges the surgeon's expertise. Several pathologies like malignancy, multinodularity, toxicity, and retrosternal extension further compounds this vascular aspect of surgery. Several structures of embryological importance such as pyramidal lobe, tubercle of Zuckerkandl, and ligament of Berry have decisive clinical implications in the surgical management of thyroid disorders. Surgeons attempting thyroidectomy need to have thorough knowledge of embryology and surgical anatomy of the thyroid gland. In this context, we highlight through a pictorial assay the embryological and anatomical aspects of the thyroid gland emphasizing on their clinical and surgical importance.
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Affiliation(s)
- P R K Bhargav
- Department of Endocrine and Metabolic Surgery, Mamata Medical College and Super Speciality Hospital (MMC/MSSH), Rotary Nagar, Khammam, 507002, Andhra Pradesh India
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97
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Stamatakos M, Paraskeva P, Katsaronis P, Tasiopoulou G, Kontzoglou K. Surgical Approach to the Management of Medullary Thyroid Cancer: When Is Lymph Node Dissection Needed? Oncology 2013; 84:350-5. [DOI: 10.1159/000351148] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 04/03/2013] [Indexed: 11/19/2022]
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98
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Abstract
BACKGROUND Transaxillary robotic thyroidectomy, developed by the Yonsei University group from Seoul, Korea, is a new approach that eliminates the need for a cervical incision. Originally, this technique was performed using a two-incision technique (ipsilateral axilla and anterior chest wall). More recently, the chest wall incision is being eliminated and a less invasive robotic thyroid procedure is being performed through a single axillary incision. SUMMARY The complexity of this new technique introduces the potential for new complications particularly during the initial learning curve that are not routinely or previously associated with conventional open thyroidectomy. This article will aide surgeons in overcoming the learning curve of transaxillary single-incision robotic thyroidectomy (TSI-RT), giving a detailed explanation of the robotic surgical procedure, the possible complications, and complication management. CONCLUSIONS If surgeons have mastery of the multiple steps of the robotic surgical procedure and a good understanding of possible complications and how to prevent them, TSI-RT can be performed safely and offers numerous advantages over multi-incision robotic thyroidectomy as well as conventional open thyroidectomy.
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Affiliation(s)
- Kee-Hyun Nam
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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99
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Agarwal A, Waghray A, Gupta S, Sharma R, Milas M. Cryopreservation of parathyroid tissue: an illustrated technique using the cleveland clinic protocol. J Am Coll Surg 2012. [PMID: 23177271 DOI: 10.1016/j.jamcollsurg.2012.09.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ashok Agarwal
- Andrology Laboratory and Sperm Bank, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44196, USA.
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100
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Campos NS, Cardoso LP, Tanios RT, Oliveira BCD, Guimarães AV, Dedivitis RA, Marcopito LF. Risk factors for incidental parathyroidectomy during thyroidectomy. Braz J Otorhinolaryngol 2012; 78:57-61. [PMID: 22392239 PMCID: PMC9443821 DOI: 10.1590/s1808-86942012000100009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 06/12/2011] [Indexed: 11/22/2022] Open
Abstract
Incidental parathyroidectomy is a common event in thyroid surgery. The literature shows a finding of parathyroid glands ranging from 6.4% to 31% in pathological specimens of the thyroid gland. Objective To collect the amount of parathyroid glands found in surgical specimens of thyroidectomy and correlate with the histopathological and demographic variables. Methods Retrospective study based on pathological reports of thyroidectomy from January 2007 to December 2008. Results 442 patients were submitted to total thyroidectomy, and 2.93% had parathyroid glands, which corresponded to 13 of this total. The presence of papillary thyroid carcinoma associated with incidental parathyroidectomy was 10.11%, compared to the benign lesion: 1.4%. Conclusion Papillary thyroid carcinoma was the variable associated with increased number of incidental parathyroidectomy.
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