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Distribution of inadvertently excised parathyroid glands during thyroid surgery and the link with post-surgical hypoparathyroidism

Published online by Cambridge University Press:  06 March 2023

A W Mayer Open the ORCID record for A W Mayer [Opens in a new window] ,
A Sharp ,
S Aziz  and
S P Balasubramanian
A W Mayer*
Affiliation:
Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
A Sharp
Affiliation:
Department of Pathology, Directorate of Laboratory Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
S Aziz
Affiliation:
Department of Pathology, Directorate of Laboratory Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
S P Balasubramanian
Affiliation:
Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
*
Corresponding author: Mr Alasdair W Mayer; Email: [email protected]
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Abstract

Objectives

To evaluate the incidence of inadvertent parathyroidectomy, identify risk factors, determine the location of inadvertently excised glands, review pathology reporting in inadvertent parathyroidectomy, and explore relationships between inadvertent parathyroidectomy and post-surgical hypoparathyroidism or hypocalcaemia.

Methods

A retrospective cohort study of 899 thyroidectomies between 2015 and 2020 was performed. Histopathology slides of patients who had an inadvertent parathyroidectomy and a random sample of patients without a reported inadvertent parathyroidectomy were reviewed.

Results

Inadvertent parathyroidectomy occurred in 18.5 per cent of thyroidectomy patients. Central neck dissection was an independent risk factor (inadvertent parathyroidectomy = 49.4 per cent with central neck dissection, 12.0 per cent without central neck dissection, p < 0.001). Most excised parathyroid glands were extracapsular (53.3 per cent), followed by subcapsular (29.1 per cent) and intrathyroidal (10.9 per cent). Parathyroid tissue was found in 10.2 per cent of specimens where no inadvertent parathyroidectomy was reported. Inadvertent parathyroidectomy was associated with a higher incidence of six-month post-surgical hypoparathyroidism or hypocalcaemia (19.8 per cent who had an inadvertent parathyroidectomy, 7.7 per cent without inadvertent parathyroidectomy).

Conclusion

Inadvertent parathyroidectomy increases the risk of post-surgical hypoparathyroidism or hypocalcaemia. The proportion of extracapsular glands contributing to inadvertent parathyroidectomy highlights the need for preventative measures.

Keywords

Thyroidectomyparathyroidectomyhypocalcemiahypoparathyroidismparathyroid hormone
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 11 , November 2023 , pp. 1226 - 1232
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Mr A Mayer takes responsibility for the integrity of the content of the paper

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