title: Is systematic identification of all four parathyroid glands necessary during total thyroidectomy?: a prospective study.
abstract: OBJECTIVE
  Routine identification of all four parathyroid glands has been advocated as a means of reducing rates of postoperative hypocalcemia and inadvertent parathyroidectomy. The object of the present study was to investigate whether identification of more parathyroid glands during thyroidectomy performed by capsular dissection technique had any impact on incidence of postoperative hypocalcemia and unintentional parathyroid resection.
  
  
  METHODS
  Prospective cohort study of consecutive patients undergoing total thyroidectomy by capsular dissection technique over a 3-year period. Exclusion criteria included performance of concomitant central neck dissection, hyperparathyroidism, revision surgery, and invasive cancer.
  
  
  METHODS
  The number of parathyroid glands identified intraoperatively was recorded. No effort was made to find glands that were not obviously apparent during the course of dissection. Patients were not placed on routine calcium supplementation.
  
  
  RESULTS
  The final study population consisted of 126 patients. The mean number of parathyroid glands identified was 2.3. The incidence of biochemical (any postoperative calcium <2 mmol/L) and clinical hypocalcemia was 22.2% and 10.3%, respectively. Patients in group A (0-2 parathyroids identified) had a significantly lower incidence of clinical hypocalcemia than patients in group B (3-4 parathyroids identified) (3.2% vs. 17.1%, P = .02). The differences in biochemical hypocalcemia were not significant (16.1% vs. 28.1%, P = .13). The incidence of inadvertent parathyroidectomy was 9.5%. There was no difference between the groups in incidence of inadvertent parathyroidectomy (9.7% vs. 9.4%, P = 1.0).
  
  
  CONCLUSIONS
  Routine identification of all four parathyroid glands is not necessary in thyroidectomy performed using capsular dissection technique.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sheahan
authors.forename: Rania
authors.initials: R
authors.lastname: Mehanna
authors.forename: Naveed
authors.initials: N
authors.lastname: Basheeth
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Murphy
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology* / Q000517:prevention & control; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000033:anatomy & histology* / Q000601:surgery; D016105:Parathyroidectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D018570:Risk Assessment; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D019564:Unnecessary Procedures
keywords: Thyroidectomy; hypocalcemia; parathyroid