title: Morbidity Associated with Concomitant Thyroid Surgery in Patients with Primary Hyperparathyroidism.
abstract: BACKGROUND
  Recurrent laryngeal nerve (RLN) palsy and hypoparathyroidism are serious complications in thyroid and parathyroid surgery. The extent to which incidentally detected thyroid nodules should be treated concomitantly is a matter of debate.
  
  
  METHODS
  This analysis was based on 1,065 patients who underwent consecutive surgery for primary hyperparathyroidism at a single institution. Together with the surgical strategy, histologic and follow-up examinations were documented prospectively and analyzed retrospectively regarding the occurrence and course of RLN palsy, hypoparathyroidism, and thyroid carcinoma.
  
  
  RESULTS
  Altogether, RLN palsy occurred for 38 patients (3.6 %) and proved to be permanent for 1 patient (0.1 %). Postoperative calcium substitution was necessary for 191 patients (17.9 %), with 3 patients showing permanent hypoparathyroidism (0.3 %). Procedures other than open minimally invasive exploration were accompanied by a significantly increased risk for temporary RLN paresis (odds ratio [OR], 6.136) and temporary hypoparathyroidism (OR 3.306). Concomitant thyroid surgery was performed for 502 patients (47.1 %). Compared with open minimally invasive parathyroid exploration, patients undergoing unilateral exploration and hemithyroidectomy (OR 5.827) or bilateral neck exploration (BNE) and thyroidectomy (OR 8.047) had a significantly increased risk for RLN paresis. Patients administered BNE with hemithyroidectomy (OR 2.380) or thyroidectomy (OR 7.233) had a significantly increased risk for hypoparathyroidism. Thyroid malignancy was incidentally detected in 86 patients (8.1 %).
  
  
  CONCLUSIONS
  Patients undergoing concomitant thyroid procedures have a significantly higher risk for temporary RLN palsy and hypoparathyroidism. However, the high rate of incidentally detected thyroid carcinoma in an iodine-replete endemic goiter area indicates hemithyroidectomy in the presence of thyroid nodules incidentally identified in preoperative ultrasounds.
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria, philipp.riss@meduniwien.ac.at.
authors.forename: Philipp
authors.initials: P
authors.lastname: Riss
authors.forename: Michael
authors.initials: M
authors.lastname: Kammer
authors.forename: Andreas
authors.initials: A
authors.lastname: Selberherr
authors.forename: Christian
authors.initials: C
authors.lastname: Scheuba
authors.forename: Bruno
authors.initials: B
authors.lastname: Niederle
mesh_terms: D002118:Calcium / Q000097:blood / Q000627:therapeutic use; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006043:Goiter, Endemic / Q000601:surgery; D006044:Goiter, Nodular / Q000601:surgery; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D007011:Hypoparathyroidism / Q000188:drug therapy / Q000209:etiology; D033162:Incidental Findings; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014826:Vocal Cord Paralysis / Q000209:etiology*
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D002118:Calcium