Complicanze in chirurgia tiroidea: ipoparatiroidismo sintomatico post-operatorio.

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COD: 115-122 Categorie: ,

Carmelo Sciumè, Girolamo Geraci, Franco Pisello, Tiziana Facella, Francesco Li Volsi, Antonella Licata, Giuseppe Modica

Ann. Ital. Chir., 2006; 77: 115-122

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INTRODUCTION: Total thyroidectomy has a definite role in the management of malignant and benign thyroid disorders,
with minimal complications and rare postoperative mortality. Even though thyroid surgery is quite safe, mechanical damage,
devascularization or inadvertent removal of the parathyroid glands are possible.
The aim of this study is to report report the personal surgical experience and to define some of the pathologic and clinical
characteristics of unintentional parathyroidectomy and post-thyroidectomy hypocalcemia
MATERIALS AND METHODS: A retrospective-observational study was carried on 313 thyroidectomies from January 2000 to
January 2004 (60 males and 253 females), mean age 41 years (range 17-86 yrs). The positions of at least 3 parathyroid
glands are defined, and are left within their fat envelope. Parathyroid glands and their vascular supply are preserved
by individual ligation of the branches of the inferior thyroid artery on the surface of thyroid lobe.
RESULTS: Over 313 thyroidectomy, in 3 cases (0.95%) the AA. accidentally removed parathyroid glands (1 superior and
2 inferior), transplanted in sternocleidomastoideus pouch. The overall incidence of temporary hypocalcemia was 5.4%
and no cases of permanent hypocalcemia were registred, regressed after medical therapy.
DISCUSSION: Prevention of complications in thyroid surgery is based on knowledge of embryology and anatomy of cervical
district, to visualize and respect the glands and their vascular pedicle: the patients must be appropriately and preoperatively
counselled regarding potential complications and they must be well aware of the surgical risk they are undertaken.
It is possible by the identifications of risk factors.
CONCLUSIONS: Postoperative hypocalcemia is the most immediate surgical complication of total thyroidectomy; it is a multifactorial
phenomenon, where surgical technique has a greater phisiopatologic impact. However, hypoparatyroidism does
not appeare to be the main reason for hypocalcemia after thyroidectomy, and other causes (surgical stress, “hungry bone
syndrome”, release of calcitonin during surgical manipulation) may be important contributory factors.
In conclusion, as we exposed, extent of resection, surgical technique and thyroid pathologic condition had a greater impact
on the rates of postoperative hypoparathyroidism.
By developing understanding of the anatomy and the ways to prevent each complication, the surgeon can minimize each
patient’s risk and can handle complications expediently and avoid worse consequence

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