Main Article Content
Background: Thyroid surgery commonly in developing countries. Hyperparathyroidism is major issue after surgery. The objective of study is to compare the occurrence of hyperparathyroidism after sub-total thyroidectomy with truncal ligation versus non-ligation of inferior thyroid artery.
Methods: Study design was randomized clinical trial. Study was conducted in public sector hospital. Surgical patients who were admitted to hospital for thyroid surgery. Participants were divided into two groups through random allocation, thyroid surgery with and without the ligation of inferior thyroid artery Thyroid surgery for group A with ligation and group B without ligation of inferior thyroid artery. Serum PTH levels were measured on 3rd post-operative day. The group A and B were compared for level of for the frequency of transient hyperparathyroidism.
Results: Mean age in group A was 40.83 yrs (SD = 9.9) and in group B it was 41.34 yrs (SD=8.73). Transient hyperparathyroidism was observed in 6.10% of patients in group A and 7.32% patients in group B and this difference was found to be statistically significant (p=0.02).
Conclusion: Result showed that ligation of artery decreased the risk of transient hyperparathyroidism after sub-total thyroidectomy.
(Acessed June 2018)
Simon G, Jonathan S. Evidence for the role of perioperative PTH measurement after total thyroidectomy as a predictor of hypocalcemia; World Journal of Surgery. 2008;32(7):1367-73.
Schmauss AK, Zech U. Concentration of calcium and phosphorus in patients after thyroidectomy without ligation of the inferior thyroid arteries. Zentralbl Chir. 1981;106(16):1063-73.
Almquist M, Hallgrimsson P, Nordenstrom E, Bergenfield A. Prediction of permanent hypoparathyroidism after total thyroidectomy. World J Surg. 2014;38: 2613–2620.
Tartaglia F, Giuliani A, Sgueglia M, et al. Is ionized calcium a reliable predictor of hypocalcemia after total thyroidectomy? A before and after study. G Chir. 2014;35: 27–35.
Lang BH, Wong KP, Cowling BJ, Fong YK, Chan DK, Hung GK. Do low preoperative Vitamin D levels reduce the accuracy of quick parathyroid hormone in predicting postthyroidectomy hypocalcaemia? Ann Surg Oncol 2013;20: 739–745.
Sciume C, Geraci G, Pisello F, Facella T, Li Volsi F, Licata A. Complications in thyroid surgery: Symptomatic post-operative hypoparathyroidism incidence, surgical technique, and treatment. Ann Ital Chir. 2006;77(2):115-22.
Halsted WS, Evans HM. The parathyroid glandules. Their blood supply and their preservation in operation upon the thyroid gland. Ann Surg. 1907;46:489-506.
Nies C, Sitter H, Zielke A, Bandorski T, Menze J, Ehlenz K. Parathyroid function following ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy. Br J Surg. 1994;81(12): 1757-59.
Park I, Rhu J, Woo JW, Choi JH, Kim JS, Kim JH. Preserving parathyroid gland vasculature to reduce post-thyroidectomy hypocalcemia. World J Surg. 2016;40: 1382–1389.
Kebsch A, Settmacher U, Lesser T. Bilateral truncal ligation of the inferior thyroid artery during bilateral subtotal thyroidectomy causes a decrease in parat-hormone without clinically manifest hypoparathyroidism: A randomized clinical trial. Eur Surg Res. 2015;55:141–150.
Antakia R, Edafe O, Uttley L, Balasubramanian SP. Effectiveness of preventative and other surgical measures on hypocalcemia following bilateral thyroid surgery: A systematic review and meta-analysis. Thyroid. 2015;25:95–106.
Kosiński B. Evaluation of the effect of ligation of the inferior thyroid arteries during non-radical thyroidectomy in simple goiter on selected parameters of calcium-phosphate metabolism in the body. Ann Acad Med Stetin. 1991;37:179-90.
Araujo Filho VJ, Silva Filho GB, Brandao LG, Santos LR, Ferraz AR. The importance of the ligation of the inferior thyroid artery in parathyroid function after subtotal thyroidectomy. Rev Hosp Clin Fac Med Sao Paulo. 2000;55(4):113-120.
Cakmakli S, Aydintug S, Erdem E. Post-thyroidectomy hypocalcemia: Does arterial ligation play a significant role? Int Surg. 1992;77(4):284-6.
Chaudhary IA, Afridi ZD, Samiullah, Masood R, Mallhi AA. To ligate or not the inferior thyroid artery to avoid hypocalcaemia after thyroid surgery. J Ayub Med Coll Abbottabad. 2007;19(2): 19-22.
Pelizzo MR, Toniato A, Grigoletto R, Piotto A, Bernante P. Post-thyroidectomy hypocalcemia and ligation of the inferior thyroid artery trunk: Minerva Chir. 1995; 50(3):215-8.
Maralcan G, Sayin Z, Başkonu I, Gökalp A, Aybasti N. Does truncal ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy affect serum calcium levels? A prospective, randomized, controlled study. Int Surg. 2006;91(4):211-6.
Jahangir S, Faisal G, Hamid H, Mohammad I. Post thyroidectomy hypocalcemia - Does arterial ligation play a significant role? Pak Armed Forces Med J. 2008;58(3):235-8.
Nawrot I, Zajac S, Grzesiuk W, Pietrasik K. Effect of surgical technique in subtotal and bilateral thyroidectomy on risk of postoperative parathyroid insufficiency development--our experience. Med Sci Monit. 2000;6(3):564-566.
Klammer F, Bauer C, Stremmel W. Standardized morphology-adjusted resection in treatment of benign nodular struma. Chir Surg. 2000;71(10): 1251-55.
Thomusch O, Machens A, Sekulla C, Ukkat J, Branckhoff M Dralle H. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: A multivariate analysis of 5846 consecutive patients. Surgery. 2003;133(2):180-5.
Dolapci M, Doganany M, Reis E, Kama NA. Truncal ligation of inferior thyroid artery does not affect the incidence of hypocalcaemia after thyroidectomy. Eur J Surg. 2000;166(4):286-8.
Khan JS, Bhopal FG, Hassan H, Iqbal M. Post thyroidectomy hypocalcemia – does arterial ligation play a significant role? Pak Armed Forces Med J. 2008;3:67-69.
Lewandowicz M, Kuzdak K, Pasieka Z. Intraoperative parathyroid hormone measurement in thyroidectomized patients: preliminary report. Endocr Regul. 2007;41 (1):29-34.
Reza A, Christian P, Klaus K, Christian S, Bruno N; Hypoparathyroidism After Total Thyroidectomy. Arch Surg. 2008;143(2): 132-37.
Yeşim E, Umut B, Artür S, Burcu T, Alp B, Selçuk Ö. The advantage of near-total thyroidectomy to avoid postoperative hypoparathyroidism in benign multinodular goiter; Langenbeck's Archives of Surgery. 2006;391(6):567-73.
Chow TL, Chu W, Lim BH, Kwok SP. Outcomes and complications of thyroid surgery: retrospective study. Hong Kong Med J. 2001;7(3):261-5.
Asari R, Passler C, Kaczirek K, Scheuba C, Niederle B. Hypoparathyroidism after total thyroidectomy: A prospective study. Arch Surg. 2008;143(2):132-7.
Spiliotis J, Vaxevanidou A, Sergouniotis F, Tsiveriotis K, Datsis A, Rogdakis A, et al. Risk factors and consequences of incidental parathyroidectomy during thyroidectomy. Am Surg. 2010;76(4):436-41.