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Incidental Parathyroidectomy During Thyroid Surgery Does Not Cause Transient Symptomatic Hypocalcemia
Aaron R. Sasson, MD;
James F. Pingpank, Jr, MD;
R. Wesley Wetherington, MD;
Alexandra L. Hanlon, PhD;
John A. Ridge, MD, PhD
Arch Otolaryngol Head Neck Surg. 2001;127:304-308.
Objectives To identify any risk factors for incidental parathyroidectomy and to
define its association with symptomatic postoperative hypocalcemia.
Design Retrospective study.
Setting Tertiary referral cancer center.
Patients Consecutive patients who underwent thyroid surgery between 1991 and
1999. Patients who underwent procedures for locally advanced thyroid cancer
requiring laryngectomy, tracheal resection, or esophagectomy were excluded.
Interventions All pathology reports were reviewed for the presence of any parathyroid
tissue in the resected specimen. Slides were reviewed, and information regarding
patient demographics, diagnosis, operative details, and postoperative complications
was collected.
Main Outcome Measure Identification of parathyroid tissue in resected specimens and postoperative
symptomatic hypocalcemia.
Results A total of 141 thyroid procedures were performed: 69 total thyroidectomies
(49%) and 72 total thyroid lobectomies (51%) . The findings were benign in
68 cases (48%) and malignant in 73 cases (52%). In the entire series, incidental
parathyroidectomy was found in 21 cases (15%). Parathyroid tissue was found
in intrathyroidal (50%), extracapsular (31%), and central node compartment
(19%) sites. The performance of a concomitant modified radical neck dissection
was associated with an increased risk of unplanned parathyroidectomy (P = .05). There was no association of incidental parathyroidectomy
with postoperative hypocalcemia (P = .99). Multivariate
analysis identified total thyroidectomy as a risk factor for postoperative
hypocalcemia (P = .008). In the entire study group,
transient symptomatic hypocalcemia occurred in 9 patients (6%), and permanent
hypocalcemia occurred in 1 patient who underwent a total thyroidectomy and
concomitant neck dissection.
Conclusions Unintended parathyroidectomy, although not uncommon, is not associated
with symptomatic postoperative hypocalcemia. Modified radical neck dissection
may increase the risk of incidental parathyroidectomy. Most of the glands
removed were intrathyroidal, so changes in surgical technique are unlikely
to markedly reduce this risk.
From the Head and Neck Surgery Section, Department of Surgical Oncology
(Drs Sasson, Pingpank, and Ridge), and the Departments of Pathology (Dr Wetherington),
Radiation Oncology (Dr Hanlon), and Biostatistics (Dr Hanlon), Fox Chase Cancer
Center, Philadelphia, Pa.
Corresponding author: John A. Ridge, MD, PhD, Head and Neck Surgery
Section, Fox Chase Cancer Center, 7701 Burholme Ave, Philadelphia, PA 19111
(e-mail: ja_ridge{at}fccc.edu).
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