Department of General Surgery, Ankara Memorial Hospital, Ankara, Turkey.
Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey.
Updates Surg. 2024 Nov;76(7):2573-2581. doi: 10.1007/s13304-024-01981-6. Epub 2024 Sep 8.
Incidental parathyroidectomy (IP) is a complication seen at varying rates after thyroid surgery, and its relationship with postoperative hypocalcemia has not been clarified. In this study, our goal was to identify the frequency and risk factors for IP in a large patient cohort and assess its correlation with postoperative hypocalcemia. A total of 4052 patients who underwent thyroid surgery between 2008 and 2020 were reviewed retrospectively. The patients were divided into two groups, the IP and non-IP groups, and compared in terms of demographics, surgical procedures, pathological diagnosis, and specimen weight. The relationships between IP and hypocalcemia were also evaluated. There were 587 (14.5%) IPs out of 4052 cases. In these patients, mostly one gland was removed (84.6%), and 23.2% of these glands were intrathyroidal. The rate of transient hypocalcemia was 39.9%, and that of permanent hypocalcemia was 1.7%. Female gender, malignancy, lower preoperative thyroid volume, presence of central lymph node dissection, lower specimen weight, presence of autotransplantation and capsule invasion in malignant cases were determined to be risk factors for IP. After excluding hemithyroidectomy and autotransplantation, transient and permanent hypocalcemia were found to be significantly higher in cases with IP (p < 0.001). Multivariate analysis showed that female sex, no multinodular goiter, central dissection, and low thyroid volume were risk-adjusted independent variables. Our findings highlight the significant role of IP in postoperative hypocalcemia. Given that most IPs are located in the perithyroidal region, precise surgical dissection is vital to preserve parathyroid gland function and prevent IP and subsequent hypocalcemia.
偶然甲状旁腺切除术（IP）是甲状腺手术后以不同比例发生的一种并发症，其与术后低钙血症的关系尚未阐明。在这项研究中，我们的目标是在大型患者队列中确定 IP 的频率和危险因素，并评估其与术后低钙血症的相关性。回顾性分析了 2008 年至 2020 年间接受甲状腺手术的 4052 例患者。将患者分为 IP 组和非 IP 组，比较两组的人口统计学、手术程序、病理诊断和标本重量。还评估了 IP 与低钙血症的关系。在 4052 例病例中，有 587 例（14.5%）发生 IP。在这些患者中，大多数切除了一个腺体（84.6%），其中 23.2%的腺体位于甲状腺内。暂时性低钙血症的发生率为 39.9%，永久性低钙血症的发生率为 1.7%。女性、恶性肿瘤、术前甲状腺体积较小、存在中央淋巴结清扫术、标本重量较低、恶性肿瘤存在自体移植和包膜侵犯被确定为 IP 的危险因素。排除半甲状腺切除术和自体移植后，发现 IP 病例的暂时性和永久性低钙血症明显更高（p < 0.001）。多变量分析显示，女性、无结节性甲状腺肿、中央解剖和低甲状腺体积是风险调整后的独立变量。我们的研究结果强调了 IP 在术后低钙血症中的重要作用。鉴于大多数 IP 位于甲状腺周围区域，精确的手术解剖对于保护甲状旁腺功能和防止 IP 及随后的低钙血症至关重要。
