Protection of parathyroid glands in thyroid surgery and treatment of postoperative hypocalcemia

Background: Hypoparathyroidism is one of the most frequent and serious complications of the thyroid surgery. Preservation of parathyroid glands (PGs) and treatment of postoperative hypocalcemia are key factors. The aim of this review is to evaluate the relevant literature and provide the clinician guidance for preservation of PGs and the formulation of individualized therapeutic strategies for patients with postoperative hypocalcemia. Methods: This was a review of preservation of PGs in thyroidectomy procedures and treatment strategies for postoperative hypocalcemia. Results: In-depth knowledge of the anatomy of PGs along with relations and an adequate preoperative assessment are the cornerstone for surgeons performing safe thyroid parathyroid surgeries. The “capsular dissection” of the thyroid lobe is the key technique to protect PGs and their supply blood vessels; the intraoperative parathyroid autotransplantation if the occasion should arise is an effective method to prevent definitive hypoparathyroidism. The patients after thyroidectomy are given monitoring of the serum calcium and parathyroid hormone (PTH); the early combinational supplement treatment of calcium and calcitriol effectively prevent postoperative hypocalcemia. Conclusion: To master the anatomic regularity of PGs, intraoperative in-situ conservation and autotransplantation of PGs, and postoperative individualized therapeutic strategies of hypoparathyroidism are effective methods to avoid hypocalcemia in thyroid surgery.