The Association of Discolored Parathyroid Glands and Hypoparathyroidism Following Total Thyroidectomy
| Autor: | Brian Hung-Hin Lang, Rita Y. K. Chang, Kai Pun Wong, Diane T. Y. Chan, Felix Che-Lok Chow |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Hypoparathyroidism medicine.medical_treatment 030230 surgery Transient hypoparathyroidism Gastroenterology Parathyroid Glands 03 medical and health sciences Postoperative Complications 0302 clinical medicine Internal medicine medicine Humans Aged Total thyroidectomy business.industry Thyroidectomy Middle Aged medicine.disease Cardiac surgery medicine.anatomical_structure Endocrinology Cardiothoracic surgery 030220 oncology & carcinogenesis Female Surgery Parathyroid gland business Abdominal surgery |
| Zdroj: | World Journal of Surgery. 40:1611-1617 |
| ISSN: | 1432-2323 0364-2313 |
| DOI: | 10.1007/s00268-016-3462-9 |
| Popis: | It remains uncertain whether a parathyroid gland (PG) that appears darkened or severely bruised but still has an attached vascular pedicle should be left in situ or taken out and auto-transplanted following total thyroidectomy. Our study aimed to examine the impact of discolored PGs (DPGs) on short- and long-term hypoparathyroidism.One hundred and three patients who underwent total thyroidectomy with 4 clearly identified PGs were analyzed. Location (superior/inferior) and color of each PG were recorded. Patients without DPG were grouped into I while those with 1-2 DPGs and ≥3 DPGs were grouped into II and III, respectively. Transient hypoparathyroidism meant adjusted Ca2.00 mol/L 24 h after surgery and/or need for supplements. Protracted hypoparathyroidism meant a subnormal PTH at 4-6 weeks and/or supplements6 weeks. Permanent hypoparathyroidism meant supplements ≥1 year.Relative to I, group III had greater adjusted Ca drop at postoperative 1-h (p = 0.012), 24-h (p 0.001) and lower day-1 PTH (p = 0.015). Having ≥3 DPGs (OR 14.00, 95 % CI 1.575-124.474, p = 0.018) was an independent factor of transient hypoparathyroidism. However, permanent hypoparathyroidism rate was higher than in group I than II (p = 0.019). Eight patients (25.8 %) in group I had undetectable day-1 PTH, while none in group III had undetectable day-1 PTH. Graves' disease/toxic goiter (OR 15.166, 95 % CI 2.594-88.661, p = 0.003) and excised gland weight (OR 1.028, 95 % CI 1.010-1.046, p = 0.003) were independent factors of ≥3 DPGs.PG discoloration is associated with transient hypoparathyroidism while normal colored PG with seemingly adequate blood supply does not always imply functionally normal gland. These findings highlights the need for a real-time intraoperative method to assess PG viability. |
| Databáze: | OpenAIRE |
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