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[In situ preservation of parathyroid glands in total or near total thyroidectomy].

OBJECTIVE
To investigate the preservation of parathyroid glands and its function during total or near-total thyroidectomy.


METHOD
One hundred and thirty one patients underwent total thyroidectomy, near total thyroidectomy, hemithyroidectomy and isthmectomy. In operation, the parathyroid glands were exposed, or were identified under microscope when necessary. The third rank of inferior thyroid arteries was ligated to preserve parathyroid glands in situ, and the parathyroid function was observed after thyroidectomy.


RESULT
Four patients (3%) had a transient hypoparathyroidism after thyroidectomy, 26 patients (20%) had a obviously biochemical hypocalcemia with no symptoms, 73 patients (56%) had a lower calcium level in the first 3 days after surgery compared with preoperative level, 28 (21%) patients who underwent ipsilateral total and contralateral subtotal isthmectomy were all normocalcemic after surgery. There were no permanent hypoparathyroidism and death in our study population.


CONCLUSION
In total or near-total thyroidectomy, parathyroid glands and its artery blood-supply should be exposed and preserved. Vasodilator and calcium supplementation should be given to patients with obviously lower serum calcium level after surgery to prevent permanent hypoparathyroidism.