Risk Factors of Incidental Parathyroidecomy in Thyroid Surgery

Potential protection of indocyanine green on parathyroid gland function during near-infrared laparoscopic-assisted thyroidectomy: A case report and literature review

BACKGROUND

In recent decades, significant advances have been made in protecting the parathyroid glands and recurrent laryngeal nerves during thyro-idectomy. However, reliable and convenient technical means are still lacking. In this study, the reliability, safety and feasibility of near-infrared (NIR) laparoscopy-assisted thyroid lobectomy with isthmectomy and prophylactic central lymph node dissection (CLND) were reported.

CASE SUMMARY

A 63-year-old female patient with a free previous medical history, was admitted to our department due to multiple thyroid nodules. Ultrasonic examination suggested diffuse thyroid changes and one thyroid nodule in the right upper lobe with the largest diameter of 1.5 cm adjacent to the trachea and Breast Imaging Reporting and Data System grade 4B. Imaging examination of the neck showed no obvious enlarged lymph nodes. Fine needle aspiration biopsy suggested a papillary thyroid carcinoma. Combined with thyroid function examination, the patient was diagnosed with papillary thyroid carcinoma and Hashimoto's thyroiditis. Considering the risk of invading the capsule and the patient's extreme anxiety, a right thyroid lobectomy with isthmectomy and prophylactic CLND was planned. No significant abnormalities were found during preoperative examinations, except for an increased thyroid stimulating hormone level. The patient underwent NIR laparoscopy-assisted thyroid lobectomy with isthmectomy and prophylactic CLND. During the operation, two right parathyroid glands (PGs) adjacent to the thyroid gland capsule and the right recurrent laryngeal nerve (RLN) were examined by indocyanine green (ICG) fluorescence using a NIR fluorescence camera, and the PGs and RLN were reliably preserved. Considering the ICG-positive PG, prophylactic CLND was performed. The postoperative parathyroid hormone level was in the normal range and no significant hypocalcemia symptoms were observed.

CONCLUSION

During NIR laparoscopy-assisted thyroidectomy, ICG fluorescence may aid PG identification and protection.

Effect of incidental parathyroidectomy on postoperative calcium levels after to-tal thyroidectomy

BACKGROUND

Incidental parathyroidectomy during total thyroidectomy may occur even in the most experienced hands. This study aims to assess the incidence, risk factors, and impact of incidental parathyroidectomy on this very targeted group of patients.

METHODS

Three hundred and four consecutive cases undergoing total thyroidectomy in a tertiary referral center were prospectively studied. Based on the histopathology report, incidental parathyroidectomy was assessed in relation to postoperative transient/permanent hypocalcemia. Demographic, clinical, and histological data were analyzed.

RESULTS

The overall incidence of unintentional removal of parathyroid glands during total thyroidectomy was 35.5 %. Indicators were the postoperative hypocalcemia, the percent change of parathormone serum levels, and the presence of lymph nodes in the histopathology report. Patients with incidental parathyroidectomy exhibited a higher incidence of transient hypocalcemia and hypoparathyroidism postoperatively.

CONCLUSIONS

Incidental parathyroidectomy is associated with transient hypocalcemia after total thyroidectomy. Even single parathyroid in the histopathology specimen may be sufficient for influencing postoperative PTH levels and calcium. Every effort should be made by surgeons to identify and protect all parathyroid glands successfully. HIPPOKRATIA 2020, 24(2): 72-76.