Preservation of the inferior thyroidal vein reduces post-thyroidectomy hypocalcemia

Abstract

Objectives/Hypothesis We present a novel surgical method to preserve the inferior thyroidal vein and investigated its effectiveness in reducing postoperative transient hypocalcemia. Study Design Retrospective cohort study. Methods From January 2012 to October 2012, 109 total thyroidectomy patients with bilateral central neck dissection were included in this study. The controls were 96 sex- and age-matched patients who underwent a conventional total thyroidectomy from January 2011 to December 2011. Differences in the incidence of postoperative hypocalcemia, serial ionized calcium levels, and postoperative day 1 intact parathyroid hormone levels were analyzed using χ2 and independent t tests. Results Age, male-to-female ratio, T stage, N stage, thyroid size, number of inadvertently excised parathyroid glands, operation time, number of harvested central lymph nodes, and total drainage amount were not significantly different between the groups. By saving the bilateral inferior thyroidal veins, the incidence of both biochemical and symptomatic hypocalcemia were significantly decreased compared to the controls (P=.044 and.012, respectively). The number of patients whose postoperative day 1 intact parathyroid hormones were <10 pg/mL was significantly lower in the study group (P=.000). Average ionized calcium levels were significantly higher in study-group patients; among the hypocalcemic patients, postoperative ionized calcium levels in the study group showed significantly faster recovery times than the control group. Conclusions The described surgical method preserves the inferior thyroidal vein and may reduce post-thyroidectomy hypocalcemia without disturbing the extent of central lymph node harvesting. Preservation of the bilateral inferior thyroidal veins is important for reducing hypocalcemia and promoting faster recovery following thyroidectomy. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.