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Preservation of the inferior thyroidal vein reduces post-thyroidectomy hypocalcemia

Authors

  • Doh Young Lee MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam-Si, South Korea
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  • Wonjae Cha MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam-Si, South Korea
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  • Woo-Jin Jeong MD, PhD,

    1. Department of Otolaryngology–Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam-Si, South Korea
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  • Soon-Hyun Ahn MD, PhD

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam-Si, South Korea
    • Send correspondence to Soon-Hyun Ahn, MD, Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Goomi-Dong, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 463–707, South Korea. E-mail: ahnsh30@snu.ac.kr

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  • Presented at the 2013 Combined Otolaryngology Spring Meetings, Orlando, Florida, U.S.A., April 10–14, 2013.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

We present a novel surgical method to preserve the inferior thyroidal vein and investigated its effectiveness in reducing postoperative transient hypocalcemia.

Study Design

Retrospective cohort study.

Methods

From January 2012 to October 2012, 109 total thyroidectomy patients with bilateral central neck dissection were included in this study. The controls were 96 sex- and age-matched patients who underwent a conventional total thyroidectomy from January 2011 to December 2011. Differences in the incidence of postoperative hypocalcemia, serial ionized calcium levels, and postoperative day 1 intact parathyroid hormone levels were analyzed using χ2 and independent t tests.

Results

Age, male-to-female ratio, T stage, N stage, thyroid size, number of inadvertently excised parathyroid glands, operation time, number of harvested central lymph nodes, and total drainage amount were not significantly different between the groups. By saving the bilateral inferior thyroidal veins, the incidence of both biochemical and symptomatic hypocalcemia were significantly decreased compared to the controls (P = .044 and .012, respectively). The number of patients whose postoperative day 1 intact parathyroid hormones were <10 pg/mL was significantly lower in the study group (P = .000). Average ionized calcium levels were significantly higher in study-group patients; among the hypocalcemic patients, postoperative ionized calcium levels in the study group showed significantly faster recovery times than the control group.

Conclusions

The described surgical method preserves the inferior thyroidal vein and may reduce post-thyroidectomy hypocalcemia without disturbing the extent of central lymph node harvesting. Preservation of the bilateral inferior thyroidal veins is important for reducing hypocalcemia and promoting faster recovery following thyroidectomy.

Level of Evidence

3b. Laryngoscope, 124:1272–1277, 2014

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