Assessment of Bone Mineral Density in Patients with Incidental Parathyroidectomy during Thyroidectomy

Introduction: Thyroid surgery for benign and malign diseases is one of the most common procedures performed in surgical practice. Complication rates are higher in malignant and inflammatory diseases, recurrent surgeries and in hyperthyroid patients. Hypocalcemia is one of these complications. There are many studies investigating the effect of incidental parathyroid tissue removal on hypocalcemia in thyroidectomy operations and investigating the risk factors for incidental parathyroidectomy. However, there are no studies investigating the effect on bone mineral density (BMD). In our study, we aimed to reveal the effect of incidental parathyroidectomy during total thyroidectomy (TT) on BMD and osteoporosis. Methods: Between January 2013 and December 2016, pathology reports of 983 patients who underwent TT, completion thyroidectomy, TT + central neck dissection, TT + functional neck dissection, TT + modified radical neck dissection were retrospectively reviewed. Seventy-two female patients with incidental parathyroid tissue were included in the study. Demographic information, post-operative biochemical values (calcium, albumin, parathyroid hormone, vitamin D, phosphorus, alkaline phosphatase), BMD, The World Health Organization Frakture Risk Assessment Tool (FRAX) fracture risks were recorded and the relationship between them was evaluated. Results: Patients were divided into three groups according to BMD: normal, osteopenic and osteoporotic. Patients in menopause and patients older than 45-years were more in osteopenic and osteoporotic group. Patients undergoing extended surgery had more parathyroids removed. There was no correlation between the number of parathyroid glands removed and hypocalcemia. After the surgery, the patients had no harmful effects on BMD and FRAX fracture risk. Conclusion: In our study, one or two parathyroid glands were removed. No effect on BMD was detected.