갑상선 절제술 후 부갑상선 기능저하증의 양상 및 부갑상선 자가이식의 효과 = Hypoparathyroidism after Thyroidectomy and the Effect of Parathyroid Autotransplantation

다국어 초록 (Multilingual Abstract)

Background and Objectives To preserve the parathyroid gland during thyroidectomy, understanding of its anatomy and physiology is essential. Parathyroid autotransplantation can be performed to restore the function of parathyroid gland. However, the efficacy of parathyroid autotransplantation is still debatable. The aim of this study was to analyze the frequency of hypoparathyroidism following thyroidectomy and evaluate the efficacy of parathyroid autotransplantation.
Subjects and Method We analyzed 449 patients who underwent thyroidectomy from January 2006 to June 2010. A total of 419 patients underwent total thyroidectomy, while 30 patients underwent unilateral lobectomy. Among the total thyroidectomy group, 96 patients underwent unilateral central neck dissection and 186 patients underwent bilateral central neck dissection. We analyzed the frequency of hypoparathyroidism according to the extent of thyroidectomy and central neck dissection, and parathyroid gland autotransplantation.
Results Transient hypoparathyroidism occurred in 20% of lobectomy patients and 54.6% of the entire thyroidectomy group. Permanent hypoparathyroidism occurred only in 7.2% of the entire thyroidectomy group. Transient and permanent hypoparathyroidism occurred in 47.4% and 6.5%, respectively, of the patients without central neck dissection, in 54.0% and 7.3%, respectively, of the patients with unilateral central neck dissection, and 60.2% and 7.5%, respectively, of the patients with bilateral central neck dissection. Parathyroid autotransplantation was performed in 29 patients of 105 patients whose one or more parathyroid glands were removed inadvertently, and permanent hypoparathyroidism did not occur among those patients.
Conclusion The frequency of transient hypoparathyroidism was increased according to the extent of thyroidectomy and central neck dissection. Parathyroid autotransplantation might be effective in minimizing permanent hypoparathyroidism.

참고문헌 (Reference)

1 태경, "갑상선 수술후 저칼슘혈증 및 반회후두신경의 손상" 대한이비인후과학회 45 (45): 1092-1097, 2002

2 Harness JK, "Total thyroidectomy: complications and technique" 10 (10): 781-786, 1986

3 Toniato A, "Thyroidectomy and parathyroid hormone: tracing hypocalcemia-prone patients" 196 (196): 285-288, 2008

4 Libutti SK, "The role of thyroid resection during reoperation for persistent or recurrent hyperparathyroidism" 122 (122): 1183-1188, 1997

5 Chisholm EJ, "Systematic review and metaanalysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone" 119 (119): 1135-1139, 2009

6 Kihara M, "Recovery of parathyroid function after total thyroidectomy: longterm follow-up study" 75 (75): 532-536, 2005

7 So YK, "Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: influence on serum thyroglobulin level, recurrence rate, and postoperative complications" 151 (151): 192-198, 2012

8 Attie JN, "Preservation of parathyroid glands during total thyroidectomy. Improved technic utilizing microsurgery" 130 (130): 399-404, 1975

9 Kikumori T, "Parathyroid autotransplantation with total thyroidectomy for thyroid carcinoma: long-term follow-up of grafted parathyroid function" 125 (125): 504-508, 1999

10 Moffett JM, "Parathyroid autotransplantation" 17 (17): 83-89, 2011

11 Asari R, "Hypoparathyroidism after total thyroidectomy: a prospective study" 143 (143): 132-138, 2008

12 Hickey RC, "Human parathyroid autotransplantation: proved function by radioimmunoassay of plasma parathyroid hormone" 110 (110): 892-895, 1975

13 Cernea CR, "How to minimize complications in thyroid surgery?" 37 (37): 1-5, 2010

14 Noordzij JP, "Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies" 205 (205): 748-754, 2007

15 Carling T, "Controversy surrounding the role for routine central lymph node dissection for differentiated thyroid cancer" 22 (22): 30-34, 2010

16 Ready AR, "Complications of thyroidectomy" 81 (81): 1555-1556, 1994

17 Reeve T, "Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient" 24 (24): 971-975, 2000

18 Bozec A, "Clinical impact of cervical lymph node involvement and central neck dissection in patients with papillary thyroid carcinoma: a retrospective analysis of 368 cases" 268 (268): 1205-1212, 2011

19 El-Sharaky MI, "Assessment of parathyroid autotransplantation for preservation of parathyroid function after total thyroidectomy" 25 (25): 799-807, 2003