Morbidity Associated with Concomitant Thyroid Surgery in Patients with Primary Hyperparathyroidism View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2014-12-06

AUTHORS

Philipp Riss, Michael Kammer, Andreas Selberherr, Christian Scheuba, Bruno Niederle

ABSTRACT

BackgroundRecurrent 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.MethodsThis 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.ResultsAltogether, 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 %).ConclusionPatients 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. More... »

PAGES

2707-2713

Identifiers

URI

http://scigraph.springernature.com/pub.10.1245/s10434-014-4283-4

DOI

http://dx.doi.org/10.1245/s10434-014-4283-4

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1040944873

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25480411


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