Unintentional parathyroidectomy during thyroidectomy

Objectives: In the United States thyroidectomy is a frequently performed su rgery by both general and head and neck surgeons. Even the most experienced thyroid surgeon, however, has probably received a pathology report stating that an incidental parathyroid gland or parathyroid tissue was found in th e submitted thyroidectomy specimen, The aim of this report is to explore so me of the pathologic and clinical characteristics of unintentional parathyr oidectomy during thyroidectomy, Study Design: A retrospective review was pe rformed of thyroidectomies performed at the University of California, Los A ngeles, Center for the Health Sciences between 1989 and June 1998 which had pathology reports showing parathyroid tissue contained within the thyroide ctomy specimen. This excluded any tissue submitted separately to be evaluat ed for parathyroid tissue and parathyroid tissue removed unintentionally du ring a thyroidectomy for a different procedure such as a laryngectomy or su rgery for parathyroid disease. Methods: The pathology slides were reviewed to determine the incidence of unintentional parathyroid tissue removal, the size of the parathyroid tissue found within the thyroid specimen, the loca tion of the parathyroid tissue (extracapsular, intracapsular, intrathyroida l), and whether this unintentional parathyroidectomy during thyroidectomy c aused clinical consequences. Results: Four hundred fourteen applicable thyr oidectomies were performed during this time with 45 (11%) discovered cases of unintentional parathyroidectomy during thyroidectomy, Twenty-five (56%) cases were discovered during thyroidectomy for benign disease, and 20 (44%) during thyroidectomy for malignant thyroid disease. All the parathyroid ti ssue was normal and was found in extracapsular (58%), intracapsular (20%), or intrathyroidal (22%) locations. Of these 45 cases, recurrent laryngeal n erve paralysis was found only in two patients who had the nerve resected in tentionally during the thyroidectomy, and none of the patients developed pe rmanent hypocalcemia, Conclusions: Incidental parathyroid gland tissue was reported in 11% of the thyroidectomies performed in our series, without the clinical consequence of hypocalcemia, The majority (78%) of this parathyro id tissue was found in the extracapsular and intracapsular locations; there fore it is possible that these parathyroid glands may be identified and pre served with more meticulous inspection of the thyroid capsule during and af ter thyroidectomy to decrease the incidence of unintentional parathyroidect omy during thyroidectomy in the future.