Kostek Mehmet, Cetinoglu Isik, Sengul Zerin, Arikan Hazal, Unlu Mehmet Taner, Caliskan Ozan, Aygun Nurcihan, Uludag Mehmet
Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Department of General Surgery, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey.
Endocrine. 2025 Apr 9. doi: 10.1007/s12020-025-04225-8.
Postoperative hypoparathyroidism is the most common complication after total thyroidectomy(TT). The clinical significance of incidental parathyroid glands(IP) detected in pathological examination of removed surgical material is still controversial. The aim of this study was to evaluate the clinical follow-up findings and risk factors of patients with IP.
Postoperative pathology results and postoperative biochemical findings of patients who underwent TT±Central Neck Dissection(CND)/Lateral Neck Dissection(LND) between September,2020 and September,2023 in single institution were retrospectively evaluated. Patients with IP were divided into Group-1, and patients without IP were divided into Group-2. Patients of Group-1 were divided as Single IP and Double IP subgroups according to the number of IP.
The findings of a total of 412 patients were evaluated. IP was detected in 90(21.8%) of the patients. Postoperative hypoparathyroidism was more common in Group-1 at the 6th hour, 24th hour and 1st month postoperatively (69.7% vs. 31.7%, p < 0.0001; 61.1% vs. 27.7%, p < 0.0001, 26.2% vs. 12.2%, p = 0.002, respectively). Persistent hypoparathyroidism was observed at a rate of 5.3% in Group-2 and 11.5% in Group-1 (p = 0.041). Postoperative hypocalcemia was seen more frequently in Group-1 than in Group-2 at the 12th hour (34.4% vs. 23.2%, p = 0.031, respectively). There was no difference between Single IP vs. Double IP groups for the serum levels of Calcium and PTH. Among the risk factors evaluated for the detection of IP, in the univariance analysis, operation indications(p = 0.018), CND(p < 0.0001), surgeon experience(p = 0.016), thyroid gland volume(p = 0.02), preoperative serum TSH value(p = 0.031); in multivariance analysis, operation type ( ± CND) (OR:2.785; 95% CI: 1.175-6.605; p = 0.020) and operator experience between 10-20 years (OR: 0.117, 95% CI: 0.033-0.418, p = 0.001) and >20 years (OR: 0.254, 95%CI: 0.085-0.760, p = 0.014) were found significant compared to operators experienced <5 years.
Patients with detected IP after total thyroidectomy have lower postoperative Calcium and PTH. Significant risk factors for the IP were low level of surgeon experience and undergoing CND.
术后甲状旁腺功能减退是全甲状腺切除术后最常见的并发症。在切除的手术标本病理检查中发现的偶然甲状旁腺（IP）的临床意义仍存在争议。本研究的目的是评估IP患者的临床随访结果及危险因素。
回顾性评估2020年9月至2023年9月在单一机构接受全甲状腺切除术±中央区淋巴结清扫（CND）/侧颈淋巴结清扫（LND）患者的术后病理结果和生化检查结果。有IP的患者分为1组，无IP的患者分为2组。1组患者根据IP数量分为单IP和双IP亚组。
共评估了412例患者的结果。90例（21.8%）患者检测到IP。术后甲状旁腺功能减退在术后第6小时、24小时和1个月时在1组中更常见（分别为69.7%对31.7%，p<0.0001；61.1%对27.7%，p<0.0001，26.2%对12.2%，p=0.002）。2组持续性甲状旁腺功能减退发生率为5.3%，1组为11.5%（p=0.041）。术后第12小时1组术后低钙血症比2组更常见（分别为34.4%对23.2%，p=0.031）。单IP组和双IP组之间血清钙和甲状旁腺激素水平无差异。在评估的IP检测危险因素中，单因素分析中，手术指征（p=0.018）、CND（p<0.0001）、外科医生经验（p=0.016）、甲状腺体积（p=0.02）、术前血清促甲状腺激素值（p=0.031）；多因素分析中，手术类型（±CND）（OR：2.785；95%CI：1.175-6.605；p=0.020）以及手术经验在10至20年（OR：0.117，95%CI：0.033-0.418，p=0.001）和大于20年（OR：0.254，95%CI：0.085-0.760，p=0.014）的医生与手术经验小于5年的医生相比有显著差异。
全甲状腺切除术后检测到IP的患者术后钙和甲状旁腺激素水平较低。IP的重要危险因素是外科医生经验不足和接受CND。
