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KMID : 1202020080010010033
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Journal of Korean Thyroid Association
2008 Volume.1 No. 1 p.33 ~ p.38
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Outcomes of Parathyroid Gland Autotransplantation in Total Thyroidectomy and Central Neck Dissection
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Hah Jeong-Hun
Sung Myung-Whun
Kim Kwang-Hyun
Choi Hyo-Geun
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Abstract
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Background and Objectives: Hypoparathyroidism is an important complication after total thyroidectomy, especially with central neck dissection. Although parathyroid gland autotransplantation (PTGAT) during thyroidectomy has been shown to reduce the incidence of permanent hypoparathyroidism, the value of the procedure during central neck dissection combined with thyroidectomy has not been reported well.
Materials and Methods: Operative principles include preservation of parathyroid glands in situ and autotransplantation of parathyroid glands inadvertently resected or devascularized during operation. Seventy-nine patients were included in this study. Among 44 patients underwent total thyroidectomy only, 25 patients underwent PTGAT. Among 35 patients received total thyroidectomy with central neck dissection, 26 patients underwent PTGAT. Immediate hypocalcemia was defined as the case with symptomatic hypocalcemia, requiring calcium supplementations. Permanent hypoparathyroidism was defined as the case with iPTH level below 10 pg/ml at postoperative 3rd month.
Results: Thirty four patients (43.0%) showed immediate hypocalcemia and 7 patients (8.9%) showed permanent hypoparathyroidism. Central neck dissection is the most important risk factor of immediate hypocalcemia (p=0.011). Though PTGAT didn’t affect outcomes in the patients underwent thyroidectomy only, it could partly reduce permanent hypoparathyroidism in the patients underwent central neck dissection combining total thyroidectomy (p=0.095).
Conclusion: PTGAT might be helpful during total thyroidectomy with central neck dissection. To get better outcomes, technical improvement in surgical dissection and PTGAT may be needed.
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KEYWORD
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Parathyroid gland aAutotransplantation, Thyroidectomy, Central neck dissection
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