Incidental parathyroidectomy during thyroidectomy: is there a real risk of hypoparathyroidism?

  • Background:
    Hypoparathyroidism is a common complication after total thyroidectomy. The incidental parathyroidectomy (PI) can occur during thyroid surgery with a percentage between 5.2% and 21.6%. The aim of this study is to evaluate the relation between incidental parathyroidectomy during thyroid surgery and post-operative hypoparathyroidism (temporary and/or definitive) (IPO).

    Retrospective analysis of 1046 consecutive patients underwent thyroid surgery from January 2016 to October 2018  was performed.

    At the final histology, we recorded parathyroid tissue in 50 patients (4.8%): 30 cases of typical parathyroid gland, 9 cases of intrathyroidal parathyroid, 10 case of parathyroid fragment and 1 case of typical parathyroid gland plus a parathyroid fragment. 12 of these 50 patients had a pre-operative diagnosis of suspicious nodule or cancer (25%). 9/12 patients (75%) underwent to thyroid surgery plus central neck dissection.In our series, we recorded IPO in 24/46 patients (52.2%), whereas in patients with no evidence of parathyroid tissue at the final histology IPO was in 256/996 (25.7 %) (P=NS).The 24 patients with IPO were treated with oral administration of ca1cium and vitamin D. None of them experienced symptoms or required endovenous administration of calcium. All of them discontinued therapy within 5 months after surgery. We also evaluated the relation between a supposed higher risk to develop IPO and preoperative vitamin D deficiency: no difference between the group with IPO (66.7%) and the group without IPO (84.6%)  (P=NS) was found.

    Discussion & Conclusion:
    PI can occur also with a correct surgical approach, in fact in about 20% of the population with PI, an intrathyroidal parathyroid  was found. PI doesn’t implicate a higher risk of hypoparathyroidism.


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