Sometimes a paper seems to come under the umbrella of "state the bleeding obvious". However, it is so vitally necessary for people to keep doing so. We should be shocked at the implication that sometimes the procedure might be done in a less than meticulous fashion, and that the parathyroids might not always be preserved. But if that is the case, it is for the best that it is stated and other doctors/surgeons cannot defend themselves by saying that all of them do the same. These ones appear so aware that of course they would do everything properly.
Another Graeco-English - or Anglo-Greek - paper for the delectation of Marz
Int J Surg. 2018 Jun 1. pii: S1743-9191(18)31486-9. doi: 10.1016/j.ijsu.2018.05.737. [Epub ahead of print]
Clinicopathological characteristics of incidental parathyroidectomy after total thyroidectomy: the effect on hypocalcemia. A retrospective cohort study.
Vasileiadis I1, Charitoudis G2, Vasileiadis D2, Stylianos K3, Karatzas T3.
1 Department of Otolaryngology/Head and Neck Surgery, Venizeleio - Pananeio General Hospital, Herakleion, Greece; Department of Otolaryngology - Head and Neck Surgery, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom. Electronic address: firstname.lastname@example.org.
2 Department of Otolaryngology - Head and Neck Surgery, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
3 Second Department of Propedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
The reported rate of incidental parathyroidectomy (IP) during total thyroidectomy varies between 6.4 to 31.1%. The aim of this study was to investigate the clinicopathological characteristics associated with IP.
MATERIALS AND METHODS:
This is a retrospective cohort study which included 2556 patients who underwent total thyroidectomy between 2002 and 2012 at a single tertiary institution. Demographics, clinicopathological risk factors, and postoperative calcium levels were compared between IP and control group.
Incidental parathyroidectomy occurred in 18.3% of patients. IP patients had higher risk of postoperative biochemical (40.3% vs 17.3%, p < 0.001) and symptomatic hypocalcemia (14.3% vs 7.3%, p < 0.001) than no-IP group. Multivariate analysis showed malignancy, tumor size > 10 mm, thyroid capsule invasion, extrathyroidal extension, lymph node metastases and central neck dissection, operation time, RLN injury, thyroid gland dimensions were independent risk factors for IP.
Our results indicate that patients with certain preoperative findings such as larger thyroid dimensions, diagnosis of malignancy and especially tumor > 10 mm, extrathyroidal extension, and lymph node metastasis are at higher risk of IP and postoperative symptomatic hypocalcemia and these patients should be adequately informed and treated. Α meticulous intraoperative identification and the preservation of all parathyroid glands results in lower incidence of IP and postoperative hypocalcemia.
Copyright © 2018. Published by Elsevier Ltd.
clinicopathological characteristics; hypocalcemia; incidental parathyroidectomy; total thyroidectomy