Shivprakash Mehta1, Muthuswamy Dhiwakar2, Krishnan Swaminathan3. 1. Departments of Otolaryngology-Head and Neck Surgery, Kovai Medical Center and Hospital, Avinashi Road, Coimbatore, 641 014, India. 2. Departments of Otolaryngology-Head and Neck Surgery, Kovai Medical Center and Hospital, Avinashi Road, Coimbatore, 641 014, India. dhiwamahi@yahoo.com. 3. Endocrinology, Kovai Medical Center and Hospital, Coimbatore, India.
Abstract
PURPOSE: To report the outcomes of parathyroid gland (PG) identification and autotransplantation (autoT) during thyroidectomy. METHODS: Consecutive total thyroidectomy cases performed by a single surgeon using extracapsular dissection technique were considered. PGs were not intentionally sought during dissection. PG location, number identified and autoT were prospectively recorded and correlated to postoperative outcomes. RESULTS: In all, 265 cases were included. The mean number of PGs identified per case was 2.7. The number of PGs identified had no correlation to postoperative hypocalcemia. However, independent risk factors for hypocalcemia were female sex, bilateral central compartment neck dissection (CND) and autoT > 1 PG; and for permanent hypoparathyroidism were female sex and bilateral CND. AutoT did not protect against permanent hypoparathyroidism. CONCLUSION: The number of PGs identified during the course of a standard extracapsular dissection technique had no correlation to postoperative hypocalcemia. Whenever possible, avoiding bilateral CND and careful techniques to preserve PGs in an in situ and viable state, to obviate the necessity for autoT, are recommended.
PURPOSE: To report the outcomes of parathyroid gland (PG) identification and autotransplantation (autoT) during thyroidectomy. METHODS: Consecutive total thyroidectomy cases performed by a single surgeon using extracapsular dissection technique were considered. PGs were not intentionally sought during dissection. PG location, number identified and autoT were prospectively recorded and correlated to postoperative outcomes. RESULTS: In all, 265 cases were included. The mean number of PGs identified per case was 2.7. The number of PGs identified had no correlation to postoperative hypocalcemia. However, independent risk factors for hypocalcemia were female sex, bilateral central compartment neck dissection (CND) and autoT > 1 PG; and for permanent hypoparathyroidism were female sex and bilateral CND. AutoT did not protect against permanent hypoparathyroidism. CONCLUSION: The number of PGs identified during the course of a standard extracapsular dissection technique had no correlation to postoperative hypocalcemia. Whenever possible, avoiding bilateral CND and careful techniques to preserve PGs in an in situ and viable state, to obviate the necessity for autoT, are recommended.