title: Parathyroid Localization and Preservation during Transcervical Resection of Substernal Thyroid Glands.
abstract: OBJECTIVE
  The feasibility of parathyroid preservation during thyroidectomy has not been well documented for cases in which the thyroid gland extends into the mediastinum.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Tertiary academic referral center.
  
  
  METHODS
  In this retrospective cohort study, 70 consecutive patients who had substernal thyroid glands treated with a transcervical thyroidectomy between 1993 and 2013 were compared with 286 thyroidectomies that did not entail substernal extension within that same time period. All localized parathyroid glands were confirmed histologically.
  
  
  RESULTS
  Of 160 possible parathyroid glands in the substernal cases, 119 (74%) were histologically confirmed intraoperatively (67 superior and 52 inferior). In nonsubsternal cases, 725 (89%) were histologically confirmed (372 superior and 353 inferior). There was a statistically significant difference between the substernal and nonsubsternal cases in the total number of glands found (P < .0001) and the number of superior and inferior glands that were identified (P = .009 and < 0.0001).
  
  
  CONCLUSIONS
  Even when the thyroid gland extends into the mediastinum, it is often possible, although with reduced efficiency, to identify and preserve the parathyroid glands.
authors.affiliation: Weill Cornell Medical College, New York, New York, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Heineman
authors.affiliation: Hofstra North Shore-Long Island Jewish School of Medicine, Department of Otolaryngology & Communicative Disorders, North Shore-Long Island Jewish Medical Center, Manhasset, New York, USA.
authors.forename: Prajoy
authors.initials: P
authors.lastname: Kadkade
authors.affiliation: Weill Cornell Medical College/New York Presbyterian, Department of Otolaryngology-Head and Neck Surgery, New York, New York, USA.
authors.forename: David I
authors.initials: DI
authors.lastname: Kutler
authors.affiliation: Weill Cornell Medical College/New York Presbyterian, Department of Otolaryngology-Head and Neck Surgery, New York, New York, USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Cohen
authors.affiliation: Weill Cornell Medical College/New York Presbyterian, Department of Otolaryngology-Head and Neck Surgery, New York, New York, USA wkuhel@med.cornell.edu.
authors.forename: William I
authors.initials: WI
authors.lastname: Kuhel
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006044:Goiter, Nodular / Q000473:pathology / Q000601:surgery; D006801:Humans; D007011:Hypoparathyroidism / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D059351:Organ Sparing Treatments / Q000379:methods*; D010280:Parathyroid Glands; D012189:Retrospective Studies; D018570:Risk Assessment; D056346:Sternotomy / Q000379:methods; D062606:Tertiary Care Centers; D013961:Thyroid Gland / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery; D016606:Thyroid Nodule / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: goiter; hypoparathyroidism; parathyroid; substernal; thyroidectomy