Journal List > J Korean Thyroid Assoc > v.7(2) > 1056557

J Korean Thyroid Assoc. 2014 Nov;7(2):149-152. Korean.
Published online November 28, 2014.  https://doi.org/10.11106/cet.2014.7.2.149
Copyright © 2014. the Korean Thyroid Association. All rights reserved.
Preservation of Parathyroid Glands during Thyroid Surgery
Jin-Woo Park
Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Korea.

Correspondence: Jin-Woo Park, MD, PhD, Department of Surgery, Chungbuk National University College of Medicine, 52 Naesudong-ro Heungduk-gu, Cheongju 361-763, Korea. Tel: 82-43-269-6033, Fax: 82-43-266-6037, Email: webjwpark@chungbuk.ac.kr
Received May 02, 2014; Revised June 13, 2014; Accepted June 24, 2014.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Hypoparathyroidism after thyroidectomy occurs as a result of devascularization or unintentional resection of the parathyroid glands. To preserve parathyroid glands, surgeons have to know well about their embryology and anatomy. The parathyroid glands vary in number, size, shape, and color. Because of more variable migration path in the neck, the inferior parathyroid glands are more widely distributed than the superior glands. The upper parathyroid glands are dorsal and the lower parathyroid glands are ventral to the coronal plane of recurrent laryngeal nerve path. Positional symmetry of superior or inferior parathyroid glands is found in approximately 70-80%. Each parathyroid gland has its own end-artery. Both the superior and inferior parathyroid glands most frequently receive blood supply from the inferior thyroid artery. Parathyroid exploration requires a meticulous and bloodless dissection with help of surgical loupes. During the superior pole dissection, every attempt should be made to dissect the gland posteriorly off the thyroid with preserving the posterior branch of the superior thyroid artery. Dissection of the lateral lobe is best achieved by capsular dissection. The tertiary branches of the inferior thyroid artery lying on the thyroid capsule are individually ligated and divided. The surgeon can also utilize positional symmetry of the parathyroid glands. If the parathyroid gland is clearly devascularized or turns deep black, it should be biopsied, confirmed as normal parathyroid tissue, and reimplanted. It is useful to search for unintentionally resected parathyroid tissue in the surgical specimen for autotransplantation at the end of the operation.

Keywords: Parathyroid; Hypoparathyroidism; Capsular dissection; Autotransplantation

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