Int J Thyroidol.  2022 Nov;15(2):68-73. 10.11106/ijt.2022.15.2.68.

Risk Factors and Prevention (New Technology) for Hypoparathyroidism after Thyroidectomy

Affiliations
  • 1Department of Surgery, Kyungpook National University, School of Medicine, Daegu, Korea

Abstract

Despite the development of various instruments and techniques for thyroid surgery, the most common complication after total thyroidectomy is hypoparathyroidism. Among them, direct damage to the parathyroid glands, unintentional removal, and blockage of blood flow are the main causes of hypoparathyroidism. In addition, preoperative risk factors include vitamin D and magnesium deficiency, hypoparathyroidism, and intraoperative risk factors include total thyroidectomy, thyroid cancer, thyroiditis, substernal or mutinodular goiter, parathyroidectomy, and lymphadenectomy. In order to preserve the function of parathyroid gland, the parathyroid gland should be identified, and the parathyroid gland and its blood vessels should be well preserved. If the parathyroid gland is unintentionally removed or the perfusion of parathyroid gland is poor, there is high possibility of permanent hypoparathyroidism after surgery, so autotransplantation of the parathyroid gland is necessary. The purpose of this article is to review the risk factors for hypoparathyroidism after total thyroidectomy and how to prevent it.

Keyword

Hypoparathyroidism; Prevention; Risk factors; Thyroidectomy

Reference

References

1. Reeve T, Thompson NW. 2000; Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg. 24(8):971–5. DOI: 10.1007/s002680010160. PMID: 10865043.
Article
2. Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H. 2003; The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery. 133(2):180–5. DOI: 10.1067/msy.2003.61. PMID: 12605179.
Article
3. Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, et al. 1998; Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg. 22(7):718–24. DOI: 10.1007/s002689900459. PMID: 9606288.
Article
4. Cisco RM. Clark OH, Duh Q-Y, Kebebew E, Gosnell JE, Shen WT, editors. Hypoparathyroidism and pseudoparathyroidism. Textbook of endocrine surgery. 3rd ed. JP Medical Ltd;2016. p. 901–4.
5. McHenry CR, Speroff T, Wentworth D, Murphy T. 1994; Risk factors for postthyroidectomy hypocalcemia. Surgery. 116(4):641–7. discussion 7–8.
6. David K, Moyson C, Vanderschueren D, Decallonne B. 2019; Long-term complications in patients with chronic hypoparathyroidism: a cross-sectional study. Eur J Endocrinol. 180(1):71–8. DOI: 10.1530/EJE-18-0580. PMID: 30407920.
7. Chen Z, Zhao Q, Du J, Wang Y, Han R, Xu C, et al. 2021; Risk factors for postoperative hypocalcaemia after thyroidectomy: a systematic review and meta-analysis. J Int Med Res. 49(3):300060521996911. DOI: 10.1177/0300060521996911. PMID: 33779362. PMCID: PMC8010841.
Article
8. McWade MA, Sanders ME, Broome JT, Solorzano CC, Mahadevan-Jansen A. 2016; Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection. Surgery. 159(1):193–202. DOI: 10.1016/j.surg.2015.06.047. PMID: 26454675. PMCID: PMC4836056.
Article
9. Vibhatavata P, Pisarnturakit P, Boonsripitayanon M, Pithuksurachai P, Plengvidhya N, Sirinvaravong S. 2020; Effect of preoperative vitamin D deficiency on hypocalcemia in patients with acute hypoparathyroidism after thyroidectomy. Int J Endocrinol. 2020:5162496. DOI: 10.1155/2020/5162496. PMID: 32774362. PMCID: PMC7396071.
Article
10. Vaitsi KD, Anagnostis P, Veneti S, Papavramidis TS, Goulis DG. 2021; Preoperative vitamin D deficiency is a risk factor for postthyroidectomy hypoparathyroidism: a systematic review and meta-analysis of observational studies. J Clin Endocrinol Metab. 106(4):1209–24. DOI: 10.1210/clinem/dgab039. PMID: 33484571.
Article
11. Garrahy A, Murphy MS, Sheahan P. 2016; Impact of postoperative magnesium levels on early hypocalcemia and permanent hypoparathyroidism after thyroidectomy. Head Neck. 38(4):613–9. DOI: 10.1002/hed.23937. PMID: 25491348.
Article
12. Minuto MN, Santori G, Ansaldo GL, Solari N, Boschetti M, Tassone C, et al. Effects of magnesium supplementation on post-thyroidectomy hypocalcemia: a prospective single-center study. Minerva Endocrinol (Torino). 2021; [Online ahead of print]. DOI: 10.23736/S2724-6507.21.03526-0. PMID: 34669318.
Article
13. Salem FA, Bergenfelz A, Nordenstrom E, Almquist M. 2021; Central lymph node dissection and permanent hypoparathyroidism after total thyroidectomy for papillary thyroid cancer: population-based study. Br J Surg. 108(6):684–90.
14. Riordan F, Murphy MS, Feeley L, Sheahan P. 2022; Association between number of parathyroid glands identified during total thyroidectomy and functional parathyroid preservation. Langenbecks Arch Surg. 407(1):297–303. DOI: 10.1007/s00423-021-02287-6. PMID: 34406491. PMCID: PMC8847165.
Article
15. Qiu Y, Fei Y, Xing Z, Zhu J, Luo Y, Su A. 2022; Does the number of autotransplanted parathyroid glands affect postoperative hypoparathyroidism and serum parathyroid hormone levels? Asian J Surg. 45(1):117–24. DOI: 10.1016/j.asjsur.2021.03.031. PMID: 33863630.
Article
16. Gan X, Feng J, Deng X, Shen F, Lu J, Liu Q, et al. 2021; The significance of Hashimoto's thyroiditis for postoperative complications of thyroid surgery: a systematic review and meta-analysis. Ann R Coll Surg Engl. 103(3):223–30. DOI: 10.1308/rcsann.2020.7013. PMID: 33645288. PMCID: PMC9158072.
Article
17. Tjahjono R, Nguyen K, Phung D, Riffat F, Palme CE. 2021; Methods of identification of parathyroid glands in thyroid surgery: a literature review. ANZ J Surg. 91(9):1711–6. DOI: 10.1111/ans.17117. PMID: 34414647.
Article
18. Weng YJ, Jiang J, Min L, Ai Q, Chen DB, Chen WC, et al. 2021; Intraoperative near-infrared autofluorescence imaging for hypocalcemia risk reduction after total thyroidectomy: evidence from a meta-analysis. Head Neck. 43(8):2523–33. DOI: 10.1002/hed.26733. PMID: 33949716.
Article
19. Demarchi MS, Baccaro M, Karenovics W, Bedat B, Triponez F. 2022; Is the indocyanine green score an accurate predictor of postoperative parathyroid hormone level? Surgery. 171(6):1526–34. DOI: 10.1016/j.surg.2021.12.036. PMID: 35164952.
Article
20. Oh E, Lee HC, Kim Y, Ning B, Lee SY, Cha J, et al. 2022; A pilot feasibility study to assess vascularity and perfusion of parathyroid glands using a portable hand-held imager. Lasers Surg Med. 54(3):399–406. DOI: 10.1002/lsm.23478. PMID: 34481419.
Article
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