SURGICAL PREVENTION AND TREATMENT OF POSTOPERATIVE HYPOPARATHYROIDISM IN PATIENTS OPERATED ON THYROID GLAND
Authors: Pasko A. Ya. 
Published: October 2020

Abstract. Thyroid gland (TG) diseases are among the most common and occupy the second place in the structure of endocrine system diseases after diabetes mellitus. The main method of TG disease treatment remains the surgical one. With the increase in the incidence of various forms of TG pathology, the number of surgeries increases including the ones performed at non-specialized in-patient facilities leading to an increase in the frequency of postoperative complications.

One of the most common specific complications after surgeries on TG is postoperative hypoparathyroidism (PHPT). It occupies a special place considering the severity of manifestations and the difficulty in prevention. It is usually caused by trauma or parathyroid glands (PTG) removal, their blood supply disturbance, as well as the development of fibrosis at the surgery site in the long term.

Therefore, the improvement of existing technologies and the development of new approaches to surgeries in case of TG diseases are relevant today. The most common method of postoperative hypoparathyroidism (PHPT) surgical prevention is precision nature of surgical manipulations with careful adhering to tactical and technical requirements for the operator: identify parathyroid glands (PTG) timely, mobilize gently, and keep their blood supply. However, it is often impossible to keep PTG intact structurally and without ischemia due to the small sizes of PTG and their vessels, anatomical and embryological features of these organs localization, the consistency and color similarity with fatty tissue, lymph nodes.

The objective of the research was to develop and evaluate the algorithm of prevention and treatment of postoperative hypoparathyroidism (PHPT) based on determining parathyroid glands (PTG) viability and the use of antihypoxant-antioxidant therapy in the postoperative period. The research was based on the results of a comprehensive examination and treatment of 60 patients who were operated for thyroid gland diseases. The patients underwent inpatient treatment at the surgical department of Ivano-Frankivsk Central City Clinical Hospital and Ivano-Frankivsk Regional Oncology Center from 2017 to 2020.

We proposed an algorithm for surgical prevention and treatment of PHPT during thyroid gland surgeries which consisted in the following. We performed a visual assessment of PTG intraoperatively and evaluated each gland from 0 to 3 points according to the degree of its viability affection.

If the gland was evaluated at 0-2 points, we left it, since there was a high probability of maintaining its function. If it was evaluated at 3 points, its autotransplantation was performed. Cytoflavin drug was applied in a dose of 10 ml per 200 0.9% NaCl intravenously once a day during 7 days in the postoperative period for the purpose of antihypoxant-antioxidant therapy.

2 groups of patients were formed in order to evaluate the effectiveness of the algorithm. Each group consisted of 30 people. Patients of Group I underwent surgery on thyroid gland according to generally accepted rules. Patients of Group II underwent interventions according to the above-mentioned algorithm.

The use of our proposed algorithm (intraoperative assessment of PTG viability and antihypoxant-antioxidant therapy in the postoperative period) significantly reduces the frequency of permanent PHP justifying indications to its application.