Post thyroidectomy hypocalcemia: physopathological considerations and prevention by homolateral sternocleidomastoid implant of a complete devascularized parathyroid gland

Abstract

Author(s): Domenico Parmeggiani, Giancarlo Moccia, Francesco Torelli, Francesco Miele, Pasquale Luongo, Pasquale Sperlongano, Al-fredo Allaria, Antonella Sciarra, Paola Della Monica, Federica Colapietra, Nadia De Falco, Maddalena Donnarumma, Chiara Colonnese, Marina Di Domenico, Paola Bassi and Massimo Agresti

Postoperative hypocalcemia incidence range after thyroid surgery from 1-2% to 61.9%. Such a wide oscillation of values in literature cannot fail to raise doubts about the method of detection and the composition of the different experiences. We here refer to the personal experience gained over the course of 3 years from January 2020 to December 2022; 320 consecutive thyroid surgeries: 79 M, 241 F, mean 49.11 Amino Acid (AA), 59 near total thyroidectomies, 213 total thyroidectomies, 48 recurrence interventions of which 18 for neoplastic pathology with central or later- cervical emptying performed in 258 cases for benign pathology and in 62 cases for cancer. In a smaller group of 50 cases of low parathyroid vascularization after dissection, we selected 12 cases of absolutely no color signal of parathyroid vascularization at early and late acquisition and in those cases, we proceeded to a homolateral sternocleidomastoid muscle implant. The entire sample of 320 patients can therefore be subdivided, according to the extent of the demolition, to the method of opotherapy substitution with L-Thyroxine and to Parathyroid ICGA (Indo-Cyanine Green Angiography) in 4 groups: I group 59 patients near total thyroidectomy; II group 155 total thyroidectomies with L-Thyroxine from 15th-30th Parathyroidectomy (PO) day; III group 94 patients total thyroidectomy with L- Thyroxine from the first PO day and finally IV group 12 patients total thyroidectomy with a muscle parathyroid implant.

In the first group the incidence of early hypocalcemia was 5 cases, equal to 8.47%, the incidence of protracted hypocalcemia was 0 cases, equal to 0%. In the second group the incidence of early hypocalcemia was 33 cases, equal to 21.29%, the incidence of protracted hypocalcemia was 7 cases, equal to 4.51%. In the third group (94 cases) the overall incidence of hypocalcemia was practically nil, with only 2 cases of early hypocalcemia, equal to 2.12% and no case of protracted hypocalcemia. In the fourth group the incidence of hypocalcemia is 1 case of early hypocalcemia 12.0% and no case of protracted hypocalcemia.

We suggest that Parathyroidectomy (PO) hypoparathyroidism doesn’t look to be influenced by total or near total thyroidectomy and that an early thyroid hormonal replacement therapy should be started, whenever possible, post total thyroidectomy. The surgical muscle implant of a completely devascularized parathyroid gland approach is certainly an interesting method, not without limits and criticisms, in an attempt to limit the iatrogenic impact in the determinism of post-thyroidectomy hypocalcemia.

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