Hamdi Taner TURGUT, Ali ÇİFTÇİ, Murat Burç YAZICIOGLU

Tiroid cerrahisinin önlenemez kabusu: İnsidental Paratiroidektomi

Amaç: Paratiroid bezinin tesadüfen çıkarılması, tiroidektominin istenmeyen küçük bir komplikasyonudur ve deneyimli merkezlerde bile meydana gelebilir. Bu çalışmanın amacı, kliniğimizin tesadüfi paratiroidektomi sonuçlarını, insidansını ve risk faktörlerini değerlendirmektir. Yöntem: Çalışmaya yaş ortalaması 50,74±12,68 olan toplam 627 hasta dahil edildi. Hastaların yüzde yetmiş sekiz nokta dokuzuna bilateral total tiroidektomi, %11,2'sine total lobektomi ile istmektomi, %4,8'ine tamamlayıcı tiroidektomi, %4'üne total tiroidektomi ile birlikte bilateral santral diseksiyonla ve %1,1'ine de bilateral subtotal tiroidektomi uygulandı. Tüm hastaların %6,4'ünde (n=40) rastlantısal paratiroidektomi görüldü. Bulgular: Tesadüfi paratiroidektomi ile bilateral total tiroidektomi ve bilateral santral boyun diseksiyonu arasında anlamlı bir korelasyon vardı. Yaş ve cinsiyet açısından tesadüfi ve tesadüfi olmayan paratiroidektomi grubu arasında istatistiksel olarak anlamlı bir fark yoktu. Preoperatif hipertiroidizm tanısı (%20,6'ya karşı %7,5) tesadüfi olmayan paratiroidektomi grubunda tesadüfi paratiroidektomi grubuna göre anlamlı olarak yüksek bulunurken, tesadüfi paratiroidektomi grubunda malignite tanısı anlamlı olarak daha yüksekti (%32,5'e karşı %11,6, p=0.001). Paratiroid lokalizasyonu açısından intratiroidal lokalize vakalarda tesadüfi paratiroidektomi oranımız daha yüksekti. Postoperatif geçici hipokalsemi (%62,5) tesadüfi paratiroidektomi grubunda tesadüfi olmayan paratiroidektomi grubuna göre daha yüksekti (%34,4, p<0,001). Sonuç: Total tiroidektomi, tiroid patolojisi ve intratiroidal yerleşimi paratiroid tesadüfi paratiroidektomi için risk faktörleridir. Tiroid cerrahisi sırasında rastlantısal paratiroidektomi potansiyel bir komplikasyon olabilir.

Anahtar Kelimeler:

Paratiroidektomi, tesadüfi, hipokalsemi

Unpredictable nightmare in thyroid surgery: Incidental Parathyroidectomy

Background: Incidental removal of the parathyroid gland is an unwanted minor complication of thyroidectomy and would occur even in experienced centers. The purpose of this study was to evaluate our clinic’s outcomes, incidence, and risk factors for incidental parathyroidectomy. Methods: A total of 627 patients with an average age of 50.74±12.68 years were included in the study. Seventy-eight point nine percent of the patients had bilateral total thyroidectomy, 11.2% had a total lobectomy with isthmectomy, 4.8% had completed thyroidectomy, 4% had bilateral total thyroidectomy with bilateral central dissection and 1.1% had bilateral subtotal thyroidectomy. Incidental parathyroidectomy was observed in 6.4% (n=40) of all patients. Results: There was a significant correlation between incidental parathyroidectomy and bilateral total thyroidectomy and bilateral central neck dissection. There were no statistically significant differences between the incidental and nonincidental parathyroidectomy group with respect to age and gender. While the preoperative diagnosis of hyperthyroidism (20.6% vs 7.5%) was significantly higher in the non-incidental parathyroidectomy group than in the incidental parathyroidectomy group, and the diagnosis of malignancy was significantly higher in the incidental parathyroidectomy group (32.5% vs. 11.6%, p=0.001). Regarding parathyroid localization, our incidental parathyroidectomy rate was higher in intrathyroidal localized cases. Postoperative transient hypocalcemia (62.5%) was higher in the incidental parathyroidectomy group than in the non-incidental parathyroidectomy group (34.4%, p<0.001). Conclusion: Total thyroidectomy, thyroid pathology, and intrathyroidal parathyroid location are risk factors for incidental parathyroidectomy. Incidental parathyroidectomy during thyroid surgery can be a potential complication.

Keywords:

Parathyroidectomy, incidental, hypocalcemia,

PDF

___

1. Allios D, Paraskevopoulos JA, Papazacharias Ch, et al. Incidental parathyroidectomy during total thyroidectomy. Hellenic J Surg. 2013;85(3):189-191. doi:10.1007/s13126-013-0035-3
2. Bergamaschi R, Becouarn G, Ronceray J, Arnaud JP. Morbidity of thyroid surgery. The American Journal of Surgery. 1998;176(1):71-75. doi:10.1016/S0002-9610(98)00099-3
3. Applewhite MK, White MG, Xiong M, et al. Incidence, Risk Factors, and Clinical Outcomes of Incidental Parathyroidectomy During Thyroid Surgery. Ann Surg Oncol. 2016;23(13):4310-4315. doi:10.1245/s10434-016-5439-1
4. Lin YS, Hsueh C, Wu HY, et al. Incidental parathyroidectomy during thyroidectomy increases the risk of postoperative hypocalcemia: Risk Factors for Incidental Parathyroidectomy. The Laryngoscope. 2017;127(9):2194-2200. doi:10.1002/lary.26448
5. Ozogul B, Akçay MN, Kisaoglu A, et al. G, Aydinli B. Incidental parathyroidectomy during thyroid surgery: risk factors, incidence, and outcomes. Turk J Med Sci. 2014;44:84-88. doi:10.3906/sag-1211-56
6. Bai B, Chen Z, Chen W. Risk factors and outcomes of incidental parathyroidectomy in thyroidectomy: A systematic review and meta-analysis. Kidane B, ed. PLoS ONE. 2018;13(11):e0207088. doi:10.1371/journal.pone.0207088
7. Park I, Rhu J, Woo JW, et al. Preserving Parathyroid Gland Vasculature to Reduce Post-thyroidectomy Hypocalcemia. World J Surg. 2016;40(6):1382-1389. doi:10.1007/s00268-016-3423-3
8. Erbil Y, Barbaros U, Ozbey N, et al. Risk factors of incidental parathyroidectomy after thyroidectomy for benign thyroid disorders. International Journal of Surgery. 2009;7(1):58-61. doi:10.1016/j.ijsu.2008.10.012
9. Sitges SA, Gallego OL, Suárez S, et al. Inadvertent parathyroidectomy during total thyroidectomy and central neck dissection for papillary thyroid carcinoma. Surgery. 2017;161(3):712-719. doi:10.1016/j.surg.2016.08.021
10. Page C, Strunski V. Parathyroid risk in total thyroidectomy for bilateral, benign, multinodular goitre: report of 351 surgical cases. J Laryngol Otol. 2007;121(3):237-241. doi:10.1017/S0022215106003501
11. Sorgaton N, Pennelli G, Bosschin IM, et al. Can we Avoid Inadvertent Parathyroidectomy during Thyroid Surgery? In Vivo. 2009;23(3):433. http://iv.iiarjournals.org/content/23/3/433.abstract
12. Manatakis DK, Balalis D, Soulou VN, et al. Incidental Parathyroidectomy during Total Thyroidectomy: Risk Factors and Consequences. International Journal of Endocrinology. 2016;2016:1-6. doi:10.1155/2016/7825305
13. Youssef T, Gaballah G, Abd-Elaal E, et al. Assessment of risk factors of incidental parathyroidectomy during thyroid surgery: A prospective study. International Journal of Surgery. 2010;8(3):207-211. doi:10.1016/j.ijsu.2009.12.008
14. Khairy GA, Al-Saif A. Incidental parathyroidectomy during thyroid resection: incidence, risk factors, and outcome. Annals of Saudi Medicine. 2011;31(3):274-278. doi:10.4103/0256-4947.81545
15. Sippel RS, Ozgul O, Hartig GK, Mack EA, Chen H. Rısks and consequences of incidental parathyroidectomy during Thyroid resection. ANZ J Surg. 2007;77(1-2):33-36. doi:10.1111/j.1445-2197.2006.03972.x
16. Phitayakorn R, McHenry CR. Incidence and location of ectopic abnormal parathyroid glands. The American Journal of Surgery. 2006;191(3):418-423. doi:10.1016/j.amjsurg.2005.10.049
17. Song CM, Jung JH, Ji YB, et al. Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy. World J Surg Onc. 2014;12(1):200. doi:10.1186/1477-7819-12-200
18. Abboud B, Sargi Z, Akkam M, et al. Risk Factors for Postthyroidectomy Hypocalcemia. Journal of the American College of Surgeons. 2002;195(4):456-461. doi:10.1016/S1072-7515(02)01310-8
19. Du W, Fang Q, Zhang X, et al. Unintentional parathyroidectomy during total thyroidectomy surgery: A single surgeon’s experience. Medicine. 2017;96(11):e6411. doi:10.1097/MD.0000000000006411
20. Sasson AR, Pingpank Jr JF, Wetherington RW, et al. Incidental Parathyroidectomy During Thyroid Surgery Does Not Cause Transient Symptomatic Hypocalcemia. Arch Otolaryngol Head Neck Surg. 2001;127(3):304. doi:10.1001/archotol.127.3.304
21. Sakorafas GH, Stafyla V, Bramis C, et al. Incidental Parathyroidectomy during Thyroid Surgery: An Underappreciated Complication of Thyroidectomy. World J Surg. 2005;29(12):1539-1543. doi:10.1007/s00268-005-0032-y
22. Åkerström G, Rudberg C, Grimelius L, et al. Causes of failed primary exploration and technical aspects of re-operation in primary hyperparathyroidism. World J Surg. 1992;16(4):562-568. doi:10.1007/BF02067321
23. Campos NS, Cardoso LP, Tanios RT, et al. Risk factors for incidental parathyroidectomy during thyroidectomy. Brazilian Journal of Otorhinolaryngology. 2012;78(1):57-61. doi:10.1590/S1808-86942012000100009
24. Rix TE, Sinha P. Inadvertent parathyroid excision during thyroid surgery. The Surgeon. 2006;4(6):339-342. doi:10.1016/S1479-666X(06)80108-3
25. Lin DT, Patel SG, Shaha AR, et al. Incidence of Inadvertent Parathyroid Removal During Thyroidectomy: The Laryngoscope. 2002;112(4):608-611. doi:10.1097/00005537-200204000-00003
26. Demeester-Mirkine N. Hypocalcemia After Thyroidectomy. Arch Surg. 1992;127(7):854. doi:10.1001/archsurg.1992.01420070118021