new technique for total thyroidectomy with preservation of parathyroid glands and function

ABSTRACT

Thyroid lobectomy is the basic thyroid operation. The most dangerous complications of this operation are permanent hypoparathyroidism and recurrent laryngeal nerve paralysis. Many attempts have been made to preserve parathyroid gland function including the use of complex microsurgical techniques, and reimplantation techniques that are not always successful. In this article we describe a new technique that preserves the parathyroid glands and their blood supply thereby avoiding permanent hypoparathyroidism. Forty seven patients were operated upon using this technique between January 1998 and March 2000. Twenty nine cases underwent total thyroidectomy [seven of them with unilateral or bilateral functional neck dissection] while eleven patients underwent lobectomy on one side and subtotal thyroidectomy on the other side. Lobectomy on one side only was performed in seven patients. Parathyroid integrity and function was demonstrated by serum calcium estimation and thalium technitium subtraction scans while recurrent laryngeal nerve integrity was demonstrated by indirect and direct laryngoscopy. There were no cases with either permanent hypoparathyroidism or recurrent laryngeal nerve injury as proved by thalium technitium scans, serum calcium and laryngoscopy. Operative time was within the normal range for comparable operations using the classic technique. No postoperative complications were noted. Total thyroid lobectomy using this technique was found to be safe, reproducible and avoids two potentially catastrophic complications. We advocate a minimum of unilateral thyroid lobectomy in all cases regardless the pathology to minimize the possibility and inherent risks involved in reexploration of both sides of the neck