Identifying Parathyroid Glands: Impact on Postoperative Hypocalcemia in Thyroidectomy

Background/Objectives: Hypoparathyroidism is a post-thyroidectomy complication with multifactorial causes. This study aimed to investigate whether identifying all four parathyroid glands (PTGs) is associated with a reduced incidence of postoperative hypocalcemia.Materials & Methods: Seventy-seven thyroidectomies, with or without neck dissection, performed by one surgeon at a single institution (March 2021 - February 2024) were retrospectively analyzed. Patients were categorized into all-four-PTGs-identified group (A) and not-all-PTGs-identified group (N) to investigate factors associated with postoperative hypocalcemia. Subgroup analyses compared hypocalcemic and normocalcemic patients within each group A and N. Patient-related factors, including surgical extent, tumor size, lymph node metastasis, extranodal (ENE) or extrathyroidal extension (ETE), were evaluated as potential risk factors.Results: Statistics revealed no significant difference in incidence of postoperative hypocalcemia between groups A and N. Lateral neck dissection was more frequent in group N (p = .004), with higher rates of lymph node metastasis (p = .010), ENE (p < .001) and ETE (p = .019). On multivariable analysis, group A versus N was not independently associated with postoperative hypocalcemia (p = .940), whereas female sex showed higher risk (p = .035). No significant differences in the patient-related factors were observed within subgroups of groups A and N.Conclusion: Systematic identification of all four PTGs during thyroid surgery does not appear to have a beneficial effect on reducing postoperative hypocalcemia. Rather, this approach may increase the risk of injury to parathyroid tissue and its blood supply. Thus, preserving these glands by thyroidal capsular dissection is considered more important.