American journal of surgery · 2024
Retracting the thyroid matters: Who develops asymptomatic transient thyrotoxicosis after parathyroidectomy.
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Wang Rongzhi, Stidham Gabe, Lovell Kelly, McMullin Jessica Liu, Gillis Andrea, Fazendin Jessica, Lindeman Brenessa, Chen Herbert
Аннотация
BACKGROUND: Hyperthyroidism after parathyroidectomy is not a well-understood complication. We sought to determine the incidence and risk factors of hyperthyroidism after parathyroidectomy.
MATERIALS AND METHODS: This is a prospective study of 91 patients undergoing parathyroidectomy. Pre- and post-operative thyroid-stimulating hormone(TSH) and free thyroxine(T4) levels at two-week follow-ups were collected. Bivariate analyses were conducted to compare demographics, laboratory results, and intraoperative findings between patients with normal and suppressed post-parathyroidectomy TSH.
RESULTS: Twenty-two(24.2 %) patients had suppressed TSH after parathyroidectomy and 2(2.2 %) reported symptoms of hyperthyroidism. All hyperthyroidism resolved within 6 weeks. No patients required medical treatment. Compared to the normal TSH group, the suppressed TSH group had significantly more bilateral explorations(91.0 % vs. 58.0 %, p = 0.006), and superior parathyroid resections(95.5 % vs. 65.2 %, p = 0.006).
CONCLUSION: Transient hyperthyroidism is common following parathyroidectomy, which is likely associated with intraoperative thyroid manipulation. Gentle retraction of thyroid glands in parathyroidectomy is warranted, especially during superior parathyroid gland resection.
MATERIALS AND METHODS: This is a prospective study of 91 patients undergoing parathyroidectomy. Pre- and post-operative thyroid-stimulating hormone(TSH) and free thyroxine(T4) levels at two-week follow-ups were collected. Bivariate analyses were conducted to compare demographics, laboratory results, and intraoperative findings between patients with normal and suppressed post-parathyroidectomy TSH.
RESULTS: Twenty-two(24.2 %) patients had suppressed TSH after parathyroidectomy and 2(2.2 %) reported symptoms of hyperthyroidism. All hyperthyroidism resolved within 6 weeks. No patients required medical treatment. Compared to the normal TSH group, the suppressed TSH group had significantly more bilateral explorations(91.0 % vs. 58.0 %, p = 0.006), and superior parathyroid resections(95.5 % vs. 65.2 %, p = 0.006).
CONCLUSION: Transient hyperthyroidism is common following parathyroidectomy, which is likely associated with intraoperative thyroid manipulation. Gentle retraction of thyroid glands in parathyroidectomy is warranted, especially during superior parathyroid gland resection.