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4 results

  • Relationship of the recurrent laryngeal nerve to the superior parathyroid gland during thyroidectomy

  • Michael Persky, Y Fang, D Myssiorek
  • Journal:
    The Journal of Laryngology & Otology / Volume 128 / Issue 4 / April 2014
    Published online by Cambridge University Press:
    25 March 2014, pp. 368-371
    Print publication:
    April 2014
  • Design:

    The relationship of the recurrent laryngeal nerve to the superior parathyroid gland during consecutive thyroidectomies was prospectively evaluated. When one structure was noted, careful dissection was performed to locate the other structure, to preserve their natural anatomical relationship.

    Patients:

    In total, 103 consecutive thyroid lobectomies were performed on 73 patients. The distance from the superior parathyroid gland to the recurrent laryngeal nerve was recorded.

    Results:

    In 88 cases (88.9 per cent), the superior parathyroid gland was identified within 5 mm of the recurrent laryngeal nerve. In 62 cases (62.6 per cent), the gland was within 1 mm of the recurrent laryngeal nerve. The height of the thyroid lobe was positively associated with the distance between the two structures (p = 0.001), as was the incidence of cancer (p = 0.033). The incidence of recurrent laryngeal nerve paresis was less than 4 per cent.

    Conclusion:

    In most cases, the recurrent laryngeal nerve was found in close proximity to the superior parathyroid gland. In a thyroid gland with a large height, or in a cancerous lobe, this relationship is less reliable.

  • Chapter 11 - Management of diabetes in paediatric surgery

  • from Section 2 - Perioperative care of the patient with diabetes mellitus
  • Edited by George M. Hall, St George's Hospital, London, Jennifer M. Hunter, University of Liverpool, Mark S. Cooper, University of Birmingham
  • Book:
    Core Topics in Endocrinology in Anaesthesia and Critical Care
    Published online:
    06 July 2010
    Print publication:
    01 April 2010, pp 109-116

  • Summary

    This chapter considers the basic anatomy and physiology of the parathyroid gland, followed by its pathologies and their implications for anaesthesia. There are usually two pairs of parathyroid gland, superior and inferior, each measuring 4 x 2 x 6 mm, surrounded by fat and each weighing approximately 25-40 mg. About 80-90% of patients have four parathyroids. Parathyroid hormone is secreted by the parathyroid chief cells in response to the fall in the level of circulating, free calcium. The clinical presentation of primary hyperparathyroidism has altered over the past century. It is a commonly recognised endocrine disorder, with the number of parathyroidectomies increasing each year. The gold standard of treatment and the only hope of cure is surgical parathyroidectomy. Preoperative intravenous infusion of methylene blue is used to identify the parathyroid glands, and in open or minimally invasive surgery the operative times can be reduced.

  • Parathyroid risk in total thyroidectomy for bilateral, benign, multinodular goitre: report of 351 surgical cases

  • C Page, V Strunski
  • Journal:
    The Journal of Laryngology & Otology / Volume 121 / Issue 3 / March 2007
    Published online by Cambridge University Press:
    23 October 2006, pp. 237-241
    Print publication:
    March 2007

  • Aims: To evaluate the risk of hypocalcaemia (transient or permanent) after total thyroidectomy for bilateral, benign, multinodular goitre, the frequency and impact of unintentional parathyroidectomy, and the value of parathyroid gland autotransplantation during thyroid surgery.

    Materials and methods: This was a retrospective study of 351 surgical patients who had undergone total thyroidectomy for bilateral, benign, multinodular goitre over a seven-year period. The primary endpoint was serum calcium concentration immediately post-operatively and during follow up. Normal serum calcium concentration was defined as 2 mmol/l. Parathyroid data were collected during surgery and histological examination.

    Results: In 62 per cent of cases, no hypocalcaemia had been observed after surgery. In 35 per cent of cases, transient hypocalcaemia had been observed after surgery. In 3 per cent of cases, chronic hypocalcaemia had been present six months after surgery. Permanent hypoparathyroidism had been diagnosed two years after surgery in 1.4 per cent of cases. Unintentional parathyroidectomy had been detected in 5.2 per cent of cases. Parathyroid gland autotransplantation had been performed in 7 per cent of cases during surgery.

    Conclusion: Permanent hypoparathyroidism is rare, although transient hypoparathyroidism occurs relatively frequently. Unintentional parathyroidectomy and parathyroid gland autotransplantation do not affect serum calcium levels.

  • Paraganglioma: an unusual tumour of the parathyroid gland

  • W. G. McCluggage, C. H. S. Cameron, D. Brooker, M. D. O'Hara
  • Journal:
    The Journal of Laryngology & Otology / Volume 110 / Issue 2 / February 1996
    Published online by Cambridge University Press:
    29 June 2007, pp. 196-199
    Print publication:
    February 1996

  • A case of paraganglioma arising within a parathyroid gland is reported. The lesion was an incidental finding in a block dissection of neck performed for squamous carcinoma of the pharynx. A well-circumscribed lesion, exhibiting the characteristic pathological features of a paraganglioma, was embedded within the right inferior parathyroid gland. Due to its location, the chief histological differential diagnosis was an unusual variant of parathyroid adenoma. Immunohistochemistry and electron microscopy assisted in reaching a diagnosis. This, as far as we are aware, is the first reported case of a paraganglioma of the parathyroid gland.