Riconoscere e “salvare” le paratiroidi in corso di tiroidectomia totale: come fare? Studio intraoperatorio

Identifying and “managing” parathyroid glands during total thyroidectomy: WHAT SHOULD BE DONE? An intraoperative study Aim. Total thyroidectomy is the most accomplished surgery for the treatment of benign and malignant thyroid disease. The most important risks of this surgery are: recurrent nerve injury and accidental removal of one or more parathyroid glands with secondary hypoparathyroidism and hypocalcemia transient or permanent. For this reason, we present the data from an anatomy and surgery study, which have been systematically researched and prepared in the course of extracapsular total thyroidectomy for thyroid disease in order to minimize the consequences of accidental parathyroid glands injury to hypoparathyroidism. Methods. Object of the study is a group of 357 patients who underwent total thyroidectomy from 2002 to 2012, during surgery, we systematically searched the parathyroid glands and collected data on the number, position, seat, symmetry, shape, color, size and vascularity. Results. Parathyroid glands were identified in 1165. The most frequently found parathyroid was the top right (307 glands, 27%) with 87% with seat to the junction of the inferior thyroid artery and recurrent. The inferior parathyroid localization has a more variable than the upper 67% in the posterior side. Despite the variability of the anatomical location of the parathyroid glands, they are arranged predominantly in a symmetrical position to the two sides of the neck. In our patients has not been any cases of permanent hypoparathyroidism or recurrent lesions. Conclusion. Only a thorough knowledge of anatomy and a rigorous surgical technique, can help the surgeon to prevent what is currently the most frequent complication in thyroid surgery. Key words: Thyroidectomy - Parathyroid glands - Hypocalcemia