Parathyroid Localization and Preservation during Transcervical Resection of Substernal Thyroid Glands.

OBJECTIVE: The feasibility of parathyroid preservation during thyroidectomy has not been well documented for cases in which the thyroid gland extends into the mediastinum.

STUDY DESIGN: Retrospective chart review.

SETTING: Tertiary academic referral center.

SUBJECTS AND METHODS: In this retrospective cohort study, 70 consecutive patients who had substernal thyroid glands treated with a transcervical thyroidectomy between 1993 and 2013 were compared with 286 thyroidectomies that did not entail substernal extension within that same time period. All localized parathyroid glands were confirmed histologically.

RESULTS: Of 160 possible parathyroid glands in the substernal cases, 119 (74%) were histologically confirmed intraoperatively (67 superior and 52 inferior). In nonsubsternal cases, 725 (89%) were histologically confirmed (372 superior and 353 inferior). There was a statistically significant difference between the substernal and nonsubsternal cases in the total number of glands found (P < .0001) and the number of superior and inferior glands that were identified (P = .009 and < 0.0001).

CONCLUSIONS: Even when the thyroid gland extends into the mediastinum, it is often possible, although with reduced efficiency, to identify and preserve the parathyroid glands.