[Complications in thyroid surgery: symptomatic post-operative hypoparathyroidism incidence, surgical technique, and treatment].
BACKGROUND
Total thyroidectomy has a definite role in the management of malignant and benign thyroid disorders, with minimal complications and rare postoperative mortality. Even though thyroid surgery is quite safe, mechanical damage, devascularization or inadvertent removal of the parathyroid glands are possible. The aim of this study is to report report the personal surgical experience and to define some of the pathologic and clinical characteristics of unintentional parathyroidectomy and post-thyroidectomy hypocalcemia.


METHODS
A retrospective-observational study was carried on 313 thyroidectomies from January 2000 to January 2004 (60 males and 253 females), mean age 41 years (range 17-86 yrs). The positions of at least 3 parathyroid glands are defined, and are left within their fat envelope. Parathyroid glands and their vascular supply are preserved by individual ligation of the branches of the inferior thyroid artery on the surface of thyroid lobe.


RESULTS
Over 313 thyroidectomy, in 3 cases (0.95%) the AA. accidentally removed parathyroid glands (1 superior and 2 inferior), transplanted in sternocleidomastoideus pouch. The overall incidence of temporary hypocalcemia was 5.4% and no cases of permanent hypocalcemia were registred, regressed after medical therapy.


CONCLUSIONS
Prevention of complications in thyroid surgery is based on knowledge of embryology and anatomy of cervical district, to visualize and respect the glands and their vascular pedicle: the patients must be appropriately and preoperatively counselled regarding potential complications and they must be well aware of the surgical risk they are undertaken. It is possible by the identifications of risk factors.


CONCLUSIONS
Postoperative hypocalcemia is the most immediate surgical complication of total thyroidectomy; it is a multifactorial phenomenon, where surgical technique has a greater phisiopatologic impact. However, hypoparatyroidism does not appeared to be the main reason for hypocalcemia after thyroidectomy, and other causes (surgical stress, "hungry bone syndrome", release of calcitonin during surgical manipulation) may be important contributory factors. In conclusion, as we exposed, extent of resection, surgical technique and thyroid pathologic condition had a greater impact on the rates of postoperative hypoparathyroidism. By developing understanding of the anatomy and the ways to prevent each complication, the surgeon can minimize each patient's risk and can handle complications expediently and avoid worse consequence.
Sciumè
Carmelo
C
Università degli Studi di Palermo, Azienda Ospedaliera, Universitaria Policlinico "P. Giaccone" Dipartimento di Chirurgia Generale, d'Urgenza e dei Trapianti di Organo (GENURTO), Sezione di Chirurgia Generale ad Indirizzo Toracico. carmesci@hotmail.com
Geraci
Girolamo
G
Pisello
Franco
F
Facella
Tiziana
T
Li Volsi
Francesco
F
Licata
Antonella
A
Modica
Giuseppe
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology*; D007011:Hypoparathyroidism / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D049449:Luminescence; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013965:Thyroidectomy / Q000009:adverse effects*
D010281:Parathyroid Hormone