A case series on the determination of pre-operative risk factors for anticipation of post operative hypocalcaemia in thyroidectomy
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20241328Keywords:
Thyroidectomy, Parathyroid, Hypocalcemia, Hypoparathyroidism, CalciumAbstract
During thyroidectomy, careful dissection of the parathyroid and tracing of their blood supply is the dictum. But it may not always be possible. We aim to highlight some of the common situations faced by ENT surgeons during thyroidectomy, where intraoperative identification and preservation of either the parathyroid glands or their blood supply may be difficult or the glands may have to be sacrificed. We wish to highlight 5 cases where hypocalcemic tetany occurred after total thyroidectomy and pre operative anticipation of their risk factors and the reasoning for the same. Extra precaution should be taken to try and identify and preserve at least one parathyroid gland to prevent lifelong morbidity due to hypocalcemia. Additionally, one must be on the lookout for such challenging cases preoperatively and appropriate consent should be taken from the patient.
References
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1-33.
Christou N, Mathonnet M. Complications after total thyroidectomy. J Visceral Surg. 2013;150(4):249-56.
Fong J, Khan A. Hypocalcemia: updates in diagnosis and management for primary care. Can Family Physician. 2012;58(2):158-62.
Hall JE, Hall ME. Guyton and Hall textbook of medical physiology e-Book. Elsevier Health Sciences. 2020.
Dedivitis RA, Aires FT, Cernea CR. Hypoparathyroidism after thyroidectomy: prevention, assessment and management. Curr Opinion Otolaryngol Head Neck Surg. 2017;25(2):142-6.
Zhou HY, He JC, McHenry CR. Inadvertent parathyroidectomy: incidence, risk factors, and outcomes. J Surg Res. 2016;205(1):70-5.
Sitges-Serra A, Gallego-Otaegui L, Suárez S, Lorente-Poch L, Munné A, Sancho JJ. Inadvertent parathyroidectomy during total thyroidectomy and central neck dissection for papillary thyroid carcinoma. Surgery. 2017;161(3):712-9.
Spiliotis J, Vaxevanidou A, Sergouniotis F, Tsiveriotis K, Datsis A, Rogdakis A, et al. Risk factors and consequences of incidental parathyroidectomy during thyroidectomy. Am Surgeon. 2010;76(4):436-41.
Yazıcıoğlu MÖ, Yılmaz A, Kocaöz S, Özçağlayan R, Parlak Ö. Risks and prediction of postoperative hypoparathyroidism due to thyroid surgery. Scientific Reps. 2021;11(1):11876.
Caglià P, Puglisi S, Buffone A, Bianco SL, Okatyeva V, Veroux M, et al. Post-thyroidectomy hypoparathyroidism, what should we keep in mind. Ann Ital Chir. 2017;6:371-81.
Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg. 2000;24:1335-41.
Erbil Y, Barbaros U, Salmaslıoğlu A, Yanık BT, Bozbora A, Özarmağan S. The advantage of near-total thyroidectomy to avoid postoperative hypoparathyroidism in benign multinodular goiter. Langenbeck's Arch Surg. 2006;391:567-73.
Orloff LA, Wiseman SM, Bernet VJ, Fahey III TJ, Shaha AR, Shindo ML, et al. American Thyroid Association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid. 2018;28(7):830-41.
Agarwal G, Aggarwal V. Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidence-based review. World J Surg. 2008;32:1313-24.
Thomusch O, Sekulla C, Dralle H. Is primary total thyroidectomy justified in benign multinodular goiter? Results of a prospective quality assurance study of 45 hospitals offering different levels of care. Surgeon. 2003;74:437-43.
Page C, Strunski V. Parathyroid risk in total thyroidectomy for bilateral, benign, multinodular goitre: report of 351 surgical cases. J Laryngol Otol. 2007;121(3):237-41.
Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian S. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. J Bri Sur. 2014;101(4):307-20.
Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery. 2003;133(2):180-5.
Al Qubaisi M, Haigh PI. Hypocalcemia after total thyroidectomy in graves disease. Permanente J. 2019;23.
Lang BH, Wong CK, Hung HT, Wong KP, Mak KL, Au KB. Indocyanine green fluorescence angiography for quantitative evaluation of in situ parathyroid gland perfusion and function after total thyroidectomy. Surgery. 2017;161(1):87-95.
Kumar A, Tyagi AK, Varshney S, Malhotra M, Priya M. Microscopic thyroidectomy: a prudent option. Indian J Otolaryngol Head Neck Surg. 2019;71:212-7.
D’orazi V, Panunzi A, Di Lorenzo E, Ortensi AL, Cialini M, Anichini S, et al. Use of loupes magnification and microsurgical technique in thyroid surgery: ten years experience in a single center. Il Giornale di Chirurgia. 2016;37(3):101.
Kumar P. The rationale of triangles in relation to thyroid surgery: A proposed unified ‘area of danger’ for safe thyroidectomy. IP Indian J Anat Surg Head Neck Brain. 2018;4(2):48-51.
Yuan Y, Li X, Bao X, Huangfu M, Zhang H. The magic mirror: a novel intraoperative monitoring method for parathyroid glands. Frontiers Endocrinol. 2023;14:1160902.
Naik AH, Wani MA, Wani KA, Laway BA, Malik AA, Shah ZA. Intraoperative parathyroid hormone monitoring in guiding adequate parathyroidectomy. Indian J Endocrinol Metabol. 2018;22(3):410.
