Risk stratification of incidental parathyroidectomy in patients undergoing thyroidectomy for nodular goiter: a retrospective cohort study

Incidental parathyroidectomy (IPT) is a potential complication of thyroidectomy and may result in significant postoperative morbidity, including hypocalcemia and hypoparathyroidism. Despite improvements in surgical techniques, IPT remains a frequent finding in pathological specimens, and its risk factors are not fully elucidated. This study aimed to determine the incidence of IPT among patients undergoing thyroidectomy for nodular goiter and to identify independent risk factors contributing to its occurrence. This retrospective cohort study included 558 patients who underwent thyroidectomy at a tertiary center between January 2021 and January 2024. Patient demographics, ultrasonographic findings, surgical data, and postoperative pathology reports were reviewed. IPT was defined as the presence of parathyroid tissue in the surgical specimen. Hypocalcemia and hypoparathyroidism were assessed through biochemical parameters. Statistical analyses included univariate and multivariate logistic regression models to determine independent predictors of IPT. Among 558 patients, the overall incidence of IPT was 19.4%. IPT was more frequently observed in female patients (p = 0.011). A significant inverse correlation was found between mediolateral nodule size and IPT incidence (p = 0.008). In multivariate analysis, female sex (OR: 2.225, 95% CI: 1.21–4.32, p = 0.011) and smaller mediolateral nodule diameter (OR: 0.969, 95% CI: 0.939–0.999, p = 0.046) were independently associated with IPT. Female patients and those with smaller thyroid nodules appear to be at higher risk for unintentional parathyroid removal. Preoperative awareness of these risk factors may support more meticulous dissection techniques and improve intraoperative decision-making.