Postoperative Hypoparathyroidism and the Viability of the Parathyroid Glands During Thyroidectomy

Overview

Journal Clin Exp Otorhinolaryngol

Date 2016 Aug 13

PMID 27515510

Citations 15

Authors

Yong Bae Ji

Chang Myeon Song

Eui Suk Sung

Jin Hyeok Jeong

Chang Beom Lee

Kyung Tae

Affiliations

Soon will be listed here.

Abstract

Objectives: To prevent hypoparathyroidism after thyroidectomy, preservation of the parathyroid glands and their vascularity are essential. The aim of this study was to determine the association between postoperative parathyroid function and the viability of the parathyroid glands during thyroidectomy.

Methods: We prospectively analyzed 111 patients who underwent total thyroidectomy and in whom all 4 parathyroid glands were preserved in situ during the operation. The surgeons scored the viability of each parathyroid gland from 0 (normal) to 3 (severely compromised viability) based on its gross appearance and vascularity intraoperatively. The index of parathyroid viability score (IPVS) was defined as the sum of the viability scores of the 4 parathyroid glands. We evaluated the relationship between postoperative parathyroid function and IPVS.

Results: Transient hypoparathyroidism occurred in 25 patients (22.5%), and permanent hypoparathyroidism in 4 patients (3.6%). The IPVS were significantly different in the three groups: 2.87±1.46 in the normal group, 3.68±1.41 in the transient hypoparathyroidism group and 7.50±1.00 in the permanent hypoparathyroidism group. The rates of transient hypoparathyroidism were 13.6% in patients with IPVS 0-2, 23.8% in patients with IPVS 3-4, and 42.9% in patients with IPVS 5-6. All the patients with IPVS of 7 or more had permanent hypoparathyroidism.

Conclusion: IPVS is correlated with the incidence of hypoparathyroidism. It could be a good quantitative indicator of the probability of hypoparathyroidism after thyroidectomy.

Citing Articles

Intraoperative Management of Parathyroid Glands and Long-Term Outcome of Parathyroid Function Following Total Thyroidectomy.

Chiang F, Lee K, Tae K, Jung K, Wang C, Hwang T Diagnostics (Basel). 2025; 15(5).

PMID: 40075841 PMC: 11899351. DOI: 10.3390/diagnostics15050593.

Impact of parathyroid gland classification on hypoparathyroidism following total thyroidectomy with central neck dissection for differentiated thyroid cancer.

Sheng Q, Li W, Zhang P, Wang Q, Zha S, Rao W Ann Med. 2025; 57(1):2476223.

PMID: 40066709 PMC: 11899267. DOI: 10.1080/07853890.2025.2476223.

Recent advances in nanomedicine for the diagnosis and therapy of thyroid disorders.

Sahare P, Ruiz-Manriquez L, Anguiano B, Banerjee A, Pathak S, Duttaroy A 3 Biotech. 2025; 15(3):67.

PMID: 40012722 PMC: 11850684. DOI: 10.1007/s13205-025-04234-4.

Assessment of ICG fluorescence in identification and preservation of parathyroid glands in thyroid surgeries and correlation with postoperative parathormone and serum calcium levels.

Lahiri A, Yadav V, Arora V, Sharma P, Dewan A Endocrine. 2025; .

PMID: 39776041 DOI: 10.1007/s12020-024-04158-8.

Impact of Indocyanine Green Angiography on Postoperative Parathyroid Function: A Propensity Score Matching Study.

Karahan S, Toprak S, Celik B, Ozata I, Yigci D, Kalender M J Clin Med. 2024; 13(11).

PMID: 38892750 PMC: 11172910. DOI: 10.3390/jcm13113038.

References

Gourgiotis S, Moustafellos P, Dimopoulos N, Papaxoinis G, Baratsis S, Hadjiyannakis E . Inadvertent parathyroidectomy during thyroid surgery: the incidence of a complication of thyroidectomy. Langenbecks Arch Surg. 2006; 391(6):557-60. DOI: 10.1007/s00423-006-0079-8. View

Kahky M, Weber R . Complications of surgery of the thyroid and parathyroid glands. Surg Clin North Am. 1993; 73(2):307-21. DOI: 10.1016/s0039-6109(16)45983-9. View

Lo C, Lam K . Routine parathyroid autotransplantation during thyroidectomy. Surgery. 2001; 129(3):318-23. DOI: 10.1067/msy.2001.111125. View

Kuhel W, Carew J . Parathyroid biopsy to facilitate the preservation of functional parathyroid tissue during thyroidectomy. Head Neck. 1999; 21(5):442-6. DOI: 10.1002/(sici)1097-0347(199908)21:5<442::aid-hed10>3.0.co;2-z. View

Sheahan P, Mehanna R, Basheeth N, Murphy M . Is systematic identification of all four parathyroid glands necessary during total thyroidectomy?: a prospective study. Laryngoscope. 2013; 123(9):2324-8. DOI: 10.1002/lary.23954. View

Lang B, Yih P, Ng K . A prospective evaluation of quick intraoperative parathyroid hormone assay at the time of skin closure in predicting clinically relevant hypocalcemia after thyroidectomy. World J Surg. 2012; 36(6):1300-6. PMC: 3348470. DOI: 10.1007/s00268-012-1561-9. View

Lee N, Blakey J, Bhuta S, Calcaterra T . Unintentional parathyroidectomy during thyroidectomy. Laryngoscope. 1999; 109(8):1238-40. DOI: 10.1097/00005537-199908000-00010. View

Bentrem D, Rademaker A, Angelos P . Evaluation of serum calcium levels in predicting hypoparathyroidism after total/near-total thyroidectomy or parathyroidectomy. Am Surg. 2001; 67(3):249-51; discussion 251-2. View

Lorente-Poch L, Sancho J, Ruiz S, Sitges-Serra A . Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg. 2015; 102(4):359-67. DOI: 10.1002/bjs.9676. View

10.

Hallgrimsson P, Nordenstrom E, Almquist M, Bergenfelz A . Risk factors for medically treated hypocalcemia after surgery for Graves' disease: a Swedish multicenter study of 1,157 patients. World J Surg. 2012; 36(8):1933-42. DOI: 10.1007/s00268-012-1574-4. View

11.

Promberger R, Ott J, Kober F, Mikola B, Karik M, Freissmuth M . Intra- and postoperative parathyroid hormone-kinetics do not advocate for autotransplantation of discolored parathyroid glands during thyroidectomy. Thyroid. 2010; 20(12):1371-5. DOI: 10.1089/thy.2010.0157. View

12.

Lo C, Lam K . Postoperative hypocalcemia in patients who did or did not undergo parathyroid autotransplantation during thyroidectomy: a comparative study. Surgery. 1998; 124(6):1081-6; discussion 1086-7. DOI: 10.1067/msy.1998.92560. View

13.

Schwartz A, Friedman E . Preservation of the parathyroid glands in total thyroidectomy. Surg Gynecol Obstet. 1987; 165(4):327-32. View

14.

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

15.

Page C, Strunski V . Parathyroid risk in total thyroidectomy for bilateral, benign, multinodular goitre: report of 351 surgical cases. J Laryngol Otol. 2006; 121(3):237-41. DOI: 10.1017/S0022215106003501. View

16.

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

17.

Cavicchi O, Piccin O, Caliceti U, De Cataldis A, Pasquali R, Ceroni A . Transient hypoparathyroidism following thyroidectomy: a prospective study and multivariate analysis of 604 consecutive patients. Otolaryngol Head Neck Surg. 2007; 137(4):654-8. DOI: 10.1016/j.otohns.2007.03.001. View

18.

Shaha A, Jaffe B . Parathyroid preservation during thyroid surgery. Am J Otolaryngol. 1998; 19(2):113-7. DOI: 10.1016/s0196-0709(98)90106-5. View

19.

Quiros R, Pesce C, Wilhelm S, Djuricin G, Prinz R . Intraoperative parathyroid hormone levels in thyroid surgery are predictive of postoperative hypoparathyroidism and need for vitamin D supplementation. Am J Surg. 2005; 189(3):306-9. DOI: 10.1016/j.amjsurg.2005.01.006. View

20.

Gauger P, Reeve T, WILKINSON M, Delbridge L . Routine parathyroid autotransplantation during total thyroidectomy: the influence of technique. Eur J Surg. 2000; 166(8):605-9. DOI: 10.1080/110241500750008240. View