Surgical audit of inadvertent parathyroidectomy during total thyroidectomy: incidence, risk factors, and outcome.

  • Rajinikanth J
  • Paul M
  • Abraham D
 et al. 
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INTRODUCTION: In experienced hands, thyroidectomy is associated with a morbidity as low as 2%[1] if parathyroid glands and laryngeal nerves are identified and preserved. Awareness of the anatomic relationship of parathyroid gland to the thyroids is important in preventing postoperative hypocalcemia. In the literature, the incidence of temporary hypocalcemia after thyroid surgery ranges from 1.6% to 50%, and permanent hypocalcemia occurs after 1.5% to 4% of surgeries.[2–6] The etiology includes surgical trauma, devascularization, and inadvertent parathyroid excision (IPE). The aim of this study was to determine the risk factors for IPE during total thyroidectomy, the incidence of intracapsular parathyroid glands, and the serum calcium levels and hospital stay of patients with IPE. PATIENTS AND METHODS: To determine the risk factors for IPE and the outcome of patients with IPE, we retrospectively reviewed the charts of all patients who had undergone total thyroidectomy from 2004 to 2006. Patients who underwent completion thyroidectomy for papillary/follicular carcinoma were also analyzed under a separate category. All surgeries were done by a surgical consultant or by a registrar under the supervision of a consultant. Data collected on each patient included age; sex; previous surgical history; diagnosis; preoperative serum calcium levels; type of operation; postoperative serum calcium levels on days 2, 3, and 4 after surgery; and length of hospital stay. Histopathology reports were scrutinized for gland weight, final diagnosis, presence of Hashimoto's thyroiditis, presence of extrathyroidal spread, presence of parathyroid gland, location of the parathyroid gland (intrathyroidal or extrathyroidal), and the pathologic features of the gland. At the time of the study, capsular dissection was used for complete removal of both lobes of the thyroid and the pyramidal lobe, with preservation of parathyroid vascularity; there was no policy of autotransplantation for devascularized glands. All visualized parathyroid glands were preserved in situ, and subcapsular glands were not sought on the thyroid specimen. Central compartment nodes were routinely dissected for medullary carcinoma and nodes that were palpable for papillary carcinoma. Palpable lateral lymph nodes were removed by a modified radical neck dissection type III. All patients routinely began receiving calcium supplements on the day after surgery, regardless of the serum calcium levels. If a patient was found to be clinically symptomatic, 1-alpha-hydroxycholecalciferol was added. Hypocalcemia was defined as a corrected serum calcium level < 8 mg/dL. Temporary hypocalcemia (biochemical) was defined as a serum calcium level

Author-supplied keywords

  • Outcome
  • Young Adult

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  • SGR: 59849091562
  • PUI: 354161602
  • SCOPUS: 2-s2.0-59849091562
  • ISSN: 1934-1997
  • PMID: 19295950


  • J Rajinikanth

  • M J Paul

  • Deepak T Abraham

  • C K Ben Selvan

  • Aravindan Nair

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