Yıl: 2016 Cilt: 3 Sayı: 1 Sayfa Aralığı: 9 - 14 Metin Dili: İngilizce İndeks Tarihi: 29-07-2022

Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy

Öz:
OBJECTIVE: The present study evaluated effects of incidental parathyroidectomy, surgical technique, and presence of thyroiditis or hyperthyroidism on occurrence of postoperative persistent or transient hypocalcemia.METHODS: Patients who underwent thyroidectomy at İstanbul Medeniyet University between 2013 and 2015 were included in the study. Patient information, postoperative serum calcium levels, and pathology reports were investigated retrospectively. Group 1 was made up of patients who were found to have hypocalcemia (calcium <=8.5 mg/dL) according to postoperative serum level and normocalcemic patients were placed in Group 2. Groups were compared statistically in terms of rate of incidental parathyroidectomy, surgical technique, and presence of thyroiditis or hyperthyroidism.RESULTS: Mean age was 49.8±12.8 years . A total of 417 patients were included in the study, 74 (17.7%) were male and 343 (82.3%) were female. Group 1 consisted of 205 (49.2%) patients who had hypocalcemia according to postoperative serum level, and remaining 212 (50.8%) patients were placed in Group 2. In Group 1, 38 (18.5%) patients had incidental parathyroidectomy, and with only 18 (8.5%) patients in Group 2, a statistically significant relationship was found between incidental parathyroidectomy and hypocalcemia (p=0.003). There was no statistically significant difference in terms of presence of thyroiditis or hyperthyroidism between groups. There was statistically significant decrease in postoperative hypocalcemia rate in patients with lobectomy compared to patients with bilateral total thyroidectomy or central neck dissection (p<0.01).CONCLUSION: Risk of postoperative hypocalcemia may be reduced with lobectomy for selected patients. In addition, delicate dissection during thyroidectomy is important in order to protect parathyroid glands and prevent hypocalcemia.
Anahtar Kelime:

Konular: Genel ve Dahili Tıp
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • Koyuncu A, Dökmetas HS, Turan M, Aydin C, Karadayi K, Bu- dak E, et al. Comparison of different thyroidectomy techniques for benign thyroid disease. Endocr J 2003;50:723-7.
  • Sun GH, DeMonner MM. Epidemiological and economic trends in impatient and outpatient thyroidectomy in the United States, 1996-2006. Thyroid 2013;23:727-33.
  • Noureldine SI, Genther DJ, Lopez M, Agrawal N, Tufano RP. Early Predictors of Hypocalcemia After Total Thyroidectomy: An Analysis of 304 Patients Using a Short-Stay Monitoring Pro- tocol, JAMA Otolaryngol Head Neck Surg 2014;140:1006-13.
  • Pattou F, Combermale F, Fabre S, Carnaille B, Decoulx M, We- meau JL, et al. Hypocalcemia following thyroid surgery: inci- dence and prediction of outcome. World J Surg 1998;22:718- 24.
  • Uludağ M. Tiroid ve paratiroid cerrahisi sonrası hipokalsemi ve tedavisi. ŞEEAH Tıp Bülteni 2014;48:161-75.
  • Erbil Y, Barbaros U, Ozbey N, Aral F, Ozarmağan S. Risk factors of incidental parathyroidectomy after thyroidectomy for benign thyroid disorders. Int J Surg 2009;7:58-61.
  • Özoğul B, Akçay MN, Kısaoğlu A, Atamanalp SŞ, Öztürk G, Aydınlı B. Incidental parathyroidectomy during thyroid sur- gery: risk factors, incidence, and outcomes. Turk J Med Sci 2014;44:84-8.
  • Baldassarre RL, Chang DC, Brumund KT, Bouvet M. Predic- tors of hypocalcemia after thyroidectomy: results from the na- tionwide inpatient sample. ISRN Surg 2012;2012:838614.
  • Campos NS, Cardoso LP, Tanios RT, Oliveira BC, Guimarães AV, Dedivitis RA, Marcopito LF. Risk factors for incidental parathyroidectomy during thyroidectomy. Braz J Otorhinolaryn- gol 2012;78:57-61.
  • Bergenfelz A, Jansson S, Kristoffersson A, Mårtensson H, Reih- nér E, Wallin G, et al. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 2008;393:667-73.
  • Lang BH, Yih PC, Ng KK. A prospective evaluation of quick intraoperative parathyroid hormone assay at the time of skin clo- sure in predicting clinically relevant hypocalcemia after thyroid- ectomy. World J Surg 2012;36:1300-6.
  • Abboud B. Topographic anatomy and arterial vascularization of the parathyroid glands: practical application. Presse Med 1996;25:1156-61.
  • Sakorafas GH, Stafyla V, Bramis C, Kotsifopoulos N, Kolettis T, Kassaras G. Incidental parathyroidectomy during thyroid sur- gery: an underappreciated complication of thyroidectomy. World J Surg 2005;29:1539-43.
  • Olson JA Jr, DeBenedetti MK, Baumann DS, Wells SA Jr. Para- thyroid autotransplantation during thyroidectomy. Results of long-term follow-up. Ann Surg 1996;223:472-8.
  • Sasson AR, Pingpank JF Jr, Wetherington RW, Hanlon AL, Ridge JA. Incidental parathyroidectomy during thyroid surgery does not cause transient symptomatic hypocalcemia. Arch Oto- laryngol Head Neck Surg 2001;127:304-8.
  • Asari R, Passler C, Kaczirek K, Scheuba C, Niederle B. Hy- poparathyroidism after total thyroidectomy. Arch Surg 2008;143:132-7.
  • Spiliotis J, Vaxevanidou A, Sergouniotis F, Tsiveriotis K, Dat- sis A, Rogdakis A, Kekelos S. Risk factors and consequences of incidental parathyroidectomy during thyroidectomy. Am Surg 2010;76:436-41.
  • Kamer E, Unalp HR, Erbil Y, Akguner T, Issever H, Tarcan E. Early prediction of hypocalcemia after thyroidectomy by para- thormone measurement in surgical site irrigation fluid. Int J Surg 2009;7:466-71.
  • Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. Systematic review and meta-analysis of predictors of post-thy- roidectomy hypocalcaemia. Br J Surg 2014;101:307-20.
  • Zambudio Ar, Rodriguez J, Riquelme J, Soria T, Canteras M, Parilla P. Prospective study of postoperative complications after total thyroidectomy for multinodular gaiters by surgeons with experience in endocrine surgery. Ann Syrg 2004;240:18-25.
  • Karamanakos SN, Markou KB, Panagopoulos K, Karavias D, Vagianos CE, Scopa CD, et al. Complications and risk factors related to the extent of surgery in thyroidectomy. Results from 2,043 procedures. Hormones (Athens) 2010;9:318-25.
  • Paek SY, Lee YM, Min SY, Kim SW, Chung KW, Youn YK. Risk factors of hypoparathyroidism following total thyroidectomy for thyroid cancer. Worl J Surg 2013;37:94-101.
  • Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery 2003;133:180-5.
  • Burge MR, Zeise TM, Johnsen MW, Conway MJ, Qualls CR. Risks of complication following thyroidectomy. J Gen Intern Med 1998;13:24-31.
  • Yetkin E, Makay Ö. Tiroidektomi komplikasyonları: Genel bakış. In: İşgör A, Uludağ M, editör. Tiroid. 1. Baskı. İstanbul: Nobel Tıp Kitabevleri; 2013. s. 941-54.
  • Delbridge L, Reeve TS, Khadra M, Poole AG. Total thyroid- ectomy: the technique of capsular dissection. Aust N Z J Surg 1992;62:96-9.
  • Sheahan P, Mehanna R, Basheeth N, Murphy MS. Is system- atic identification of all four parathyroid glands necessary dur- ing total thyroidectomy?: a prospective study. Laryngoscope 2013;123:2324-8.
  • Sierra M, Herrera MF, Herrero B, Jiménez F, Sepşlveda J, Lo- zano RR, et al. Prospective biochemical and scintigraphic evalua- tion of autografted normal parathyroid glands in patients under- going thyroid operations. Surgery 1998;124:1005-10.
APA ÖZEMİR İ, Buldanlı M, YENER o, Leblebici M, Eren T, Baysal H, Alimoglu O (2016). Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy. , 9 - 14.
Chicago ÖZEMİR İbrahim Ali,Buldanlı Mehmet Zeki,YENER oktay,Leblebici Metin,Eren Tunc,Baysal Hakan,Alimoglu Orhan Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy. (2016): 9 - 14.
MLA ÖZEMİR İbrahim Ali,Buldanlı Mehmet Zeki,YENER oktay,Leblebici Metin,Eren Tunc,Baysal Hakan,Alimoglu Orhan Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy. , 2016, ss.9 - 14.
AMA ÖZEMİR İ,Buldanlı M,YENER o,Leblebici M,Eren T,Baysal H,Alimoglu O Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy. . 2016; 9 - 14.
Vancouver ÖZEMİR İ,Buldanlı M,YENER o,Leblebici M,Eren T,Baysal H,Alimoglu O Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy. . 2016; 9 - 14.
IEEE ÖZEMİR İ,Buldanlı M,YENER o,Leblebici M,Eren T,Baysal H,Alimoglu O "Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy." , ss.9 - 14, 2016.
ISNAD ÖZEMİR, İbrahim Ali vd. "Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy". (2016), 9-14.
APA ÖZEMİR İ, Buldanlı M, YENER o, Leblebici M, Eren T, Baysal H, Alimoglu O (2016). Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy. İstanbul Kuzey Klinikleri, 3(1), 9 - 14.
Chicago ÖZEMİR İbrahim Ali,Buldanlı Mehmet Zeki,YENER oktay,Leblebici Metin,Eren Tunc,Baysal Hakan,Alimoglu Orhan Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy. İstanbul Kuzey Klinikleri 3, no.1 (2016): 9 - 14.
MLA ÖZEMİR İbrahim Ali,Buldanlı Mehmet Zeki,YENER oktay,Leblebici Metin,Eren Tunc,Baysal Hakan,Alimoglu Orhan Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy. İstanbul Kuzey Klinikleri, vol.3, no.1, 2016, ss.9 - 14.
AMA ÖZEMİR İ,Buldanlı M,YENER o,Leblebici M,Eren T,Baysal H,Alimoglu O Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy. İstanbul Kuzey Klinikleri. 2016; 3(1): 9 - 14.
Vancouver ÖZEMİR İ,Buldanlı M,YENER o,Leblebici M,Eren T,Baysal H,Alimoglu O Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy. İstanbul Kuzey Klinikleri. 2016; 3(1): 9 - 14.
IEEE ÖZEMİR İ,Buldanlı M,YENER o,Leblebici M,Eren T,Baysal H,Alimoglu O "Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy." İstanbul Kuzey Klinikleri, 3, ss.9 - 14, 2016.
ISNAD ÖZEMİR, İbrahim Ali vd. "Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy". İstanbul Kuzey Klinikleri 3/1 (2016), 9-14.