Postoperative Hypoparathyroidism and the Viability of the Parathyroid Glands During Thyroidectomy

Yong Bae Ji, Chang Myeon Song, Eui Suk Sung, Jin Hyeok Jeong, Chang Beom Lee, Kyung Tae, Yong Bae Ji, Chang Myeon Song, Eui Suk Sung, Jin Hyeok Jeong, Chang Beom Lee, Kyung Tae

Abstract

Objectives: To prevent hypoparathyroidism after thyroidectomy, preservation of the parathyroid glands and their vascularity are essential. The aim of this study was to determine the association between postoperative parathyroid function and the viability of the parathyroid glands during thyroidectomy.

Methods: We prospectively analyzed 111 patients who underwent total thyroidectomy and in whom all 4 parathyroid glands were preserved in situ during the operation. The surgeons scored the viability of each parathyroid gland from 0 (normal) to 3 (severely compromised viability) based on its gross appearance and vascularity intraoperatively. The index of parathyroid viability score (IPVS) was defined as the sum of the viability scores of the 4 parathyroid glands. We evaluated the relationship between postoperative parathyroid function and IPVS.

Results: Transient hypoparathyroidism occurred in 25 patients (22.5%), and permanent hypoparathyroidism in 4 patients (3.6%). The IPVS were significantly different in the three groups: 2.87±1.46 in the normal group, 3.68±1.41 in the transient hypoparathyroidism group and 7.50±1.00 in the permanent hypoparathyroidism group. The rates of transient hypoparathyroidism were 13.6% in patients with IPVS 0-2, 23.8% in patients with IPVS 3-4, and 42.9% in patients with IPVS 5-6. All the patients with IPVS of 7 or more had permanent hypoparathyroidism.

Conclusion: IPVS is correlated with the incidence of hypoparathyroidism. It could be a good quantitative indicator of the probability of hypoparathyroidism after thyroidectomy.

Keywords: Hypocalcemia; Hypoparathyroidism; Parathyroid Glands; Thyroidectomy.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Scoring of parathyroid gland viability according to intraoperative gross appearance and vascularity. (A) Black arrow indicates normal parathyroid with score 0, and white arrow indicates moderately compromised parathyroid with score 2. (B) Black arrow head indicates mildly compromised parathyroid with score 1. (C) White arrow head indicates severely compromised parathyroid with score 3.
Fig. 2.
Fig. 2.
Mean index of parathyroid viability score (IPVS) according to the postoperative parathyroid function. IPVS is significantly different in the three groups.

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