{"title":"Intraoperative Management of Parathyroid Glands and Long-Term Outcome of Parathyroid Function Following Total Thyroidectomy.","authors":"Feng-Yu Chiang, Kang Dae Lee, Kyung Tae, Kwang Yoon Jung, Chih-Chun Wang, Tzer-Zen Hwang, Che-Wei Wu, Shih-Wei Wang, Yu-Chen Shih, Tzu-Yen Huang","doi":"10.3390/diagnostics15050593","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background/Objectives:</b> In situ preservation is the primary strategy to preserve parathyroid gland (PG) function during thyroid surgery, while autotransplantation is used when inadvertent removal or devascularization occurs. Deciding on the optimal approach intraoperatively for exposed PGs remains challenging. This study evaluates intraoperative PG management strategies and long-term outcomes of PG function following total thyroidectomy. <b>Methods:</b> This retrospective study included 543 patients undergoing primary total thyroidectomy, excluding those with comorbid parathyroid disease. A stabbing test assessed the vascular supply of exposed PGs. PGs with fresh blood oozing after the test were preserved in situ; otherwise, they were autotransplanted. Intact parathyroid hormone (iPTH) and ionized calcium (iCa) were measured preoperatively and on postoperative day 1 (PO-1D), and during follow-up. Permanent hypoparathyroidism (PHPS) was defined as iPTH < 15 pg/mL, iCa < 4.2 mg/dL, or continued need for calcitriol or calcium supplementation after a postoperative period of 12 months (PO-12M). The PHPS rate was compared with the corresponding intraoperative PG status. <b>Results:</b> A total of 528 patients were enrolled in this study. At PO-1D, 434 patients (82.2%) had iPTH ≥ 15 pg/mL, 65 (12.3%) had iPTH between 4 and 15 pg/mL, and 29 (5.5%) had iPTH < 4 pg/mL. At PO-12M, 527 patients (99.81%) had iPTH ≥ 15 pg/mL, 1 (0.19%) had iPTH between 4 and 15 pg/mL, and none had iPTH < 4 pg/mL. Five patients (0.95%) were in PHPS after PO-12M. Among the 462 patients with at least one viable PG preserved in situ, the PHPS rate was 0.2%, compared to 6.1% (66 patients) for those without a viable PG preserved in situ (<i>p</i> < 0.001). <b>Conclusions:</b> Permanent hypoparathyroidism is rare when at least one viable PG is preserved in situ during total thyroidectomy. The stabbing test is a simple, useful, and cost-effective method to assess the vascular supply of exposed PGs, providing surgeons with essential information for intraoperative PG management.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"15 5","pages":""},"PeriodicalIF":3.0000,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11899351/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diagnostics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3390/diagnostics15050593","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Background/Objectives: In situ preservation is the primary strategy to preserve parathyroid gland (PG) function during thyroid surgery, while autotransplantation is used when inadvertent removal or devascularization occurs. Deciding on the optimal approach intraoperatively for exposed PGs remains challenging. This study evaluates intraoperative PG management strategies and long-term outcomes of PG function following total thyroidectomy. Methods: This retrospective study included 543 patients undergoing primary total thyroidectomy, excluding those with comorbid parathyroid disease. A stabbing test assessed the vascular supply of exposed PGs. PGs with fresh blood oozing after the test were preserved in situ; otherwise, they were autotransplanted. Intact parathyroid hormone (iPTH) and ionized calcium (iCa) were measured preoperatively and on postoperative day 1 (PO-1D), and during follow-up. Permanent hypoparathyroidism (PHPS) was defined as iPTH < 15 pg/mL, iCa < 4.2 mg/dL, or continued need for calcitriol or calcium supplementation after a postoperative period of 12 months (PO-12M). The PHPS rate was compared with the corresponding intraoperative PG status. Results: A total of 528 patients were enrolled in this study. At PO-1D, 434 patients (82.2%) had iPTH ≥ 15 pg/mL, 65 (12.3%) had iPTH between 4 and 15 pg/mL, and 29 (5.5%) had iPTH < 4 pg/mL. At PO-12M, 527 patients (99.81%) had iPTH ≥ 15 pg/mL, 1 (0.19%) had iPTH between 4 and 15 pg/mL, and none had iPTH < 4 pg/mL. Five patients (0.95%) were in PHPS after PO-12M. Among the 462 patients with at least one viable PG preserved in situ, the PHPS rate was 0.2%, compared to 6.1% (66 patients) for those without a viable PG preserved in situ (p < 0.001). Conclusions: Permanent hypoparathyroidism is rare when at least one viable PG is preserved in situ during total thyroidectomy. The stabbing test is a simple, useful, and cost-effective method to assess the vascular supply of exposed PGs, providing surgeons with essential information for intraoperative PG management.
DiagnosticsBiochemistry, Genetics and Molecular Biology-Clinical Biochemistry
CiteScore
4.70
自引率
8.30%
发文量
2699
审稿时长
19.64 days
期刊介绍:
Diagnostics (ISSN 2075-4418) is an international scholarly open access journal on medical diagnostics. It publishes original research articles, reviews, communications and short notes on the research and development of medical diagnostics. There is no restriction on the length of the papers. Our aim is to encourage scientists to publish their experimental and theoretical research in as much detail as possible. Full experimental and/or methodological details must be provided for research articles.