J Endocr Surg.  2018 Jun;18(2):121-131. 10.16956/jes.2018.18.2.121.

Prevention, Identification and Management of Postoperative Hypoparathyroidism

• Lazzara S
• Barbera A
• Zanghì GN
• Freni F
• Pagano G
• Cogliandolo A
• Makay O
• Dionigi G

• KMID: 2420767
• DOI: http://doi.org/10.16956/jes.2018.18.2.121

Abstract

The objective of this article is to detail and present our experience on the incidence and management of parathyroid dysfunction after thyroid surgery. Selective evaluation of original articles and reviews that were retrieved by a PubMed search over the years 1990 to 2018, as well as of the recommendations of medical societies including the American, European and Asian Thyroid/Endocrine Associations. The literature presents several contributions, with controversial results. The recommended management for the diagnosis and treatment of parathyroid dysfunction after bilateral thyroid surgery or recurrent surgery consists of an intact parathyroid hormone (iPTH) determination 12-24 hours after surgery and calcium substitution in iPTH < 15 pg/mL, no substitution with iPTH ≥15 pg/mL. This procedure is safe for the patient and is accepted by patients and social insurances (for short hospital stay).

Keyword

Thyroid gland; Thyroid disease; Parathyroid glands; Parathyroid hormone

MeSH Terms

Asian Continental Ancestry Group
Calcium
Diagnosis
Humans
Hypoparathyroidism*
Incidence
Parathyroid Glands
Parathyroid Hormone
Societies, Medical
Thyroid Diseases
Thyroid Gland
Calcium
Parathyroid Hormone

Figure

• 

  Fig. 1. The terms “superior” and “inferior” refer to a gland's embryologic origin. (A) The superior parathyroid glands are usually one to 2 centimeters cranial to the junction of the RLN with the inferior thyroid artery and within 1 cm of the entry point for the RLN into the ligament of Berry and the cricoid cartilage. Superior parathyroid glands can be undescended, or can be parapharyngeal, retropharyngeal, or retrotracheal within the middle cervical/mediastinal compartment. (B) The 2 inferior parathyroid glands reside in the anterior mediastinal compartment, anterior to the RLN. They are most often found in the thyrothymic tract, or just inside the thyroid capsule on the inferior portion of the thyroid lobes. The parathyroid glands are variable in number: 3 or more small glands. Occasionally, some individuals may have 6, 8, or even more parathyroid glands. RLN = recurrent laryngeal nerve.

• 

  Fig. 2. The superior parathyroid glands receive their blood and drainage from the inferior thyroid vessels in more than 90% of cases, rarely from the superior ones. The inferior parathyroid glands receive a variable blood supply, from either the ascending branch of the inferior thyroid arteries or the thyroid ima artery. The inferior thyroid artery arises from the subclavian arteries. Each parathyroid vein drains into the superior, middle and inferior thyroid veins. The superior and middle thyroid veins drain into the internal jugular vein, and the inferior thyroid vein drains into the brachiocephalic vein.

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  Fig. 3. Identification and preservation of parathyroid gland. (A) Transoral endoscopic thyroidectomy vestibular approach. (B) Open conventional thyroidectomy.

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  Fig. 4. ICG as near-infrared fluorescent dye for real-time in situ parathyroid glands perfusion monitoring. ICG = indocyanine green.

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