[Avoidance and Management of Hypoparathyroidism After Thyroid Gland Surgery]

Overview

Journal Chirurg

Specialty General Surgery

Date 2014 Dec 16

PMID 25502498

Citations 2

Authors

A Selberherr

B Niederle

Affiliations

Soon will be listed here.

Abstract

Postoperative hypoparathyroidism after bilateral thyroid gland surgery or after interventions for recurrence is defined as intact parathyroid hormone levels (iPTH) < 15 pg/ml with simultaneous normal, below normal and markedly decreased serum calcium levels. After bilateral thyroid surgery and after reoperations a single iPTH measurement performed 12-24 h postoperatively can be used to predict parathyroid metabolism. Patients with an iPTH level ≥ 15 pg/ml may be discharged safely, patients with an iPTH < 10 pg/ml must be substituted with calcium and vitamin D and patients with an iPTH between 10 and 15 pg/ml (grey zone) may be discharged if a second measurement 48 h after surgery documents an iPTH ≥ 15 pg/ml. This procedure increases the length of hospital stay. Patients in the (grey zone) must be substituted. The iPTH level and its course determine the necessity, dose and length of calcium and vitamin D substitution.

Citing Articles

Measurement of serum intact parathyroid hormone concentration 1 day after total thyroidectomy to assess risk of permanent hypoparathyroidism.

Zheng J, Cai S, Song H, Wang Y, Han X, Han G J Int Med Res. 2020; 48(6):300060520927199.

PMID: 32527180 PMC: 7294503. DOI: 10.1177/0300060520927199.

Enhanced visualization of parathyroid glands during video-assisted neck surgery.

Alesina P, Meier B, Hinrichs J, Mohmand W, Walz M Langenbecks Arch Surg. 2018; 403(3):395-401.

PMID: 29536247 DOI: 10.1007/s00423-018-1665-2.

References

Grodski S, Serpell J . Evidence for the role of perioperative PTH measurement after total thyroidectomy as a predictor of hypocalcemia. World J Surg. 2008; 32(7):1367-73. DOI: 10.1007/s00268-008-9545-5. View

Selberherr A, Scheuba C, Riss P, Niederle B . Postoperative hypoparathyroidism after thyroidectomy: efficient and cost-effective diagnosis and treatment. Surgery. 2014; 157(2):349-53. DOI: 10.1016/j.surg.2014.09.007. View

Mohebati A, Shaha A . Anatomy of thyroid and parathyroid glands and neurovascular relations. Clin Anat. 2011; 25(1):19-31. DOI: 10.1002/ca.21220. View

Niederle B, Roka R, Brennan M . The transplantation of parathyroid tissue in man: development, indications, technique, and results. Endocr Rev. 1982; 3(3):245-79. DOI: 10.1210/edrv-3-3-245. View

Bergenfelz A, Jansson S, Kristoffersson A, Martensson H, Reihner E, Wallin G . Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg. 2008; 393(5):667-73. DOI: 10.1007/s00423-008-0366-7. View

Doran H, England J, Palazzo F . Questionable safety of thyroid surgery with same day discharge. Ann R Coll Surg Engl. 2012; 94(8):543-7. PMC: 3954278. DOI: 10.1308/003588412X13373405384576. View

Dionigi G, Van Slycke S, Rausei S, Boni L, Dionigi R . Parathyroid function after open thyroidectomy: A prospective randomized study for ligasure precise versus harmonic FOCUS. Head Neck. 2012; 35(4):562-7. DOI: 10.1002/hed.23005. View

Dralle H . [Postoperative hypoparathyroidism: central neck dissection is a significant risk factor]. Chirurg. 2012; 83(12):1082. DOI: 10.1007/s00104-012-2400-0. View

Veyseller B, Aksoy F, Yildirim Y, Karatas A, Ozturan O . Effect of recurrent laryngeal nerve identification technique in thyroidectomy on recurrent laryngeal nerve paralysis and hypoparathyroidism. Arch Otolaryngol Head Neck Surg. 2011; 137(9):897-900. DOI: 10.1001/archoto.2011.134. View

10.

Shaha A, Burnett C, Jaffe B . Parathyroid autotransplantation during thyroid surgery. J Surg Oncol. 1991; 46(1):21-4. DOI: 10.1002/jso.2930460106. View

11.

Sitges-Serra A, Ruiz S, Girvent M, Manjon H, Duenas J, Sancho J . Outcome of protracted hypoparathyroidism after total thyroidectomy. Br J Surg. 2010; 97(11):1687-95. DOI: 10.1002/bjs.7219. View

12.

Barczynski M, Konturek A, Stopa M, Cichon S, Richter P, Nowak W . Total thyroidectomy for benign thyroid disease: is it really worthwhile?. Ann Surg. 2011; 254(5):724-29. DOI: 10.1097/SLA.0b013e3182360118. View

13.

Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau J . Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg. 1998; 22(7):718-24. DOI: 10.1007/s002689900459. View

14.

Zedenius J, Wadstrom C, Delbridge L . Routine autotransplantation of at least one parathyroid gland during total thyroidectomy may reduce permanent hypoparathyroidism to zero. Aust N Z J Surg. 1999; 69(11):794-7. DOI: 10.1046/j.1440-1622.1999.01697.x. View

15.

Policeni B, Smoker W, Reede D . Anatomy and embryology of the thyroid and parathyroid glands. Semin Ultrasound CT MR. 2012; 33(2):104-14. DOI: 10.1053/j.sult.2011.12.005. View

16.

Hallgrimsson P, Nordenstrom E, Bergenfelz A, Almquist M . Hypocalcaemia after total thyroidectomy for Graves' disease and for benign atoxic multinodular goitre. Langenbecks Arch Surg. 2012; 397(7):1133-7. DOI: 10.1007/s00423-012-0981-1. View

17.

Reeve T, Thompson N . 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. 2000; 24(8):971-5. DOI: 10.1007/s002680010160. View

18.

Testini M, Nacchiero M, Piccinni G, Portincasa P, Di Venere B, Lissidini G . Total thyroidectomy is improved by loupe magnification. Microsurgery. 2004; 24(1):39-42. DOI: 10.1002/micr.10195. View

19.

Barczynski M, Cichon S, Konturek A, Cichon W . Applicability of intraoperative parathyroid hormone assay during total thyroidectomy as a guide for the surgeon to selective parathyroid tissue autotransplantation. World J Surg. 2008; 32(5):822-8. DOI: 10.1007/s00268-007-9405-8. View

20.

Riss P, Kaczirek K, Heinz G, Bieglmayer C, Niederle B . A "defined baseline" in PTH monitoring increases surgical success in patients with multiple gland disease. Surgery. 2007; 142(3):398-404. DOI: 10.1016/j.surg.2007.05.004. View