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Year : 2015  |  Volume : 28  |  Issue : 4  |  Page : 807-812

Parathyroid gland injuries during total and subtotal thyroidectomy

1 Department of General Surgery, Faculty of Medicine, Menoufia University, Zagazig, Sharkia, Egypt
2 Resident of General Surgery at Ministry of Health, Zagazig, Sharkia, Egypt

Correspondence Address:
Yaser A Saleh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1110-2098.173595

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Objective The aim of this study was to identify the incidence, risk factors and the clinical relevance of incidental parathyroid excision during total and subtotal thyroidectomy in thyroid diseases. Background Postoperative hypocalcaemia is observed in total thyroidectomy patients and it is the most common complication. It is usually transient, and the incidence of permanent hyperparathyroidism is 3% or less. Despite being self-limiting in most patients, symptomatic hypocalcaemia is of particular concern because of a delay in its manifestation and the consequent need for prolonged patient hospitalization or readmission. Patients and methods In this randomized prospective study, we surveyed 30 patients who were admitted in the General Surgery Department, Menoufia University Hospital, during the period from November 2012 to March 2014 with benign thyroid diseases such as simple multinodular goiter, secondary toxic goiter, diffuse toxic goiter relapsing after full medical treatment, selected cases of thyroiditis (Hashimoto's thyroiditis) and thyroid cancer. Results We found two cases with temporary hypocalcaemia with multinodular goiter and medullary carcinoma. The typical signs and symptoms associated with hypocalcaemia are neuromuscular irritability, including perioral or acral paresthesia, muscle cramps that may progress to carpopedal spasm, laryngospasm, bronchospasm or even tetany. Treatment is based on the severity of symptoms. In severe cases (calcium levels less than 7.5% or severe symptoms), intravenous calcium salts are administered using one ampoule of calcium gluconate in 1 l of 5% dextrose at an initial infusion rate of 100 ml/h. With frequent monitoring of the serum calcium level (usually every 1-2 h), the infusion rate is titrated to keep the serum calcium level in the low normal range. Conclusion Incidental parathyroid excision during thyroid resection is not uncommon, and it occurred in 16.4% of the cases in this series. Total thyroidectomy, extra thyroid extension of the tumour, and thyroiditis were found to be the risk factors for incidental parathyroid excision.

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