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Objective: To evaluate the effect of glucocorticoid used in perioperative period of total thyroidectomy (TT) plus central compartment lymph node dissection (CCLND) or combining with lateral neck dissection on postoperative hypoparathyroidism (HPT) and hypocalcemia (HPC). Methods: The data of 117 patients with papillary thyroid carcinoma (PTC) undergone the surgeries in Tongren Hospital between Nov 2015 and Mar 2017 were retrospectively analyzed. There were 36 males and 81 females, and their ages ranged from 21 to 74 years old, average age of 47.8±12.5. TT and CCLND were performed in 81 (69.2%) patients, and TT, CCLND and unilateral or bilateral lateral neck dissection were performed in 36 (30.8%) patients. The patients were divided into 4 groups: Group A (40 patients), no glucocorticoid was applied; Group B (36 patients), 5 mg dexmethasone sodium phosphate was sprayed on the surface of wound on both sides of trachea during operation; Group C (21 patients), 40 mg methylprednisolone was applied by intravenous injection after operation, one time per day for 3 days; Group D (20 patients), 5 mg dexmethasone sodium phosphate was sprayed on the surface of wound on both sides of trachea during operation and 40 mg methylprednisolone were applied by intravenous injection after operation, one time per day for 3 days. Serum parathyroid hormone and calcium were tested before operation and at the 1(st), 2(nd) and 3(rd) day after operation. Spss19.0 was used to analyze the data. Results: There were statistically significant differences in the incidences of both no HPT and no HPC and the incidence of HPT alone between Group A and B (35.0% vs 61.1%, 15.0% vs 2.8%, χ(2) were 5.182 and 3.885, respectively, P <0.05), but not in the incidence of HPC alone between the two groups. There were statistically significant difference in the incidences of both no HPT and no HPC between Group A and D (35% vs 70.0%, χ(2)=6.530, P <0.05), but not in the incidences of HPT or HPC between the two groups. There were not statistically significant differences in the individual incidences between Groups A and C ( P >0.05). There were statistically significant differences in the incidence of both no HPT and no HPC and the incidence of HPT alone between Groups B and C (61.1% vs 23.8%, 2.8% vs 23.8%, χ(2) were 7.402 and 6.229, respectively, P <0.05), but not in the incidence of HPC between the two groups ( P >0.05). HPT and HPC often occurred on the 1(st) or 2(nd) day after operation. Permanent hypocalcemia did not occur in all cases. Conclusions: Intraoperative especially plus post-operative application of glucocorticoid can decrease the incidence of HPT after operation.

Objective: To explore the protection methods of parathyroid glands (PTGs) and their functions during total thyroidectomy., Methods: The locations and the blood supplies of parathyroid glands in 292 cases underwent total thyroidectomy between February 1990 and December 2009 were studied. The protective measures for PTGs and their blood supplies during total thyroidectomy were analyzed., Results: Total of 542 superior PTGs and 467 inferior PTGs were found in 296 cases of total thyroidectomy. Of the superior PTGs, 444 (81.9%) consistently located in the back sides of the thyroid glands and at the level of inferior edge of thyroid cartilage. The locations of the inferior PTGs were variable, 231 (49.5%) of them located in the inferior 1/3 part of the back sides of the thyroids and 116 (24.8%) at the inferior thyroid, in where inferior thyroid artery (ITA) branches enter thyroid. The fine dissections showed that the blood supplies to superior PTGs were mainly from the upper branch of ITA, accounting for 71 (68.3%) of 104 superior PTGs and the blood supplies to inferior PTGs were from the inferior branches of ITA system, accounting for 114 (80.3%) of 142 inferior PTGs. There was 13 cases with short-term hypocalcemia postoperatively, but no case with permanent hypoparathyroidism., Conclusions: The blood supplies of PTGs are associated with their locations. During total or subtotal thyroidectomy, parathyroid glands and their artery blood-supply should be exposed and preserved to prevent hypoparathyroidism after surgery.

Objective: To evaluate the effect of protecting parathyroid glands in situ in the operation of total thyroidectomy by detecting parathyroid hormone after the operation., Methods: In the surgical team, 1019 consecutive patients with thyroid diseases were treated with total thyroidectomy. During the operation, parathyroid glands were protected in situ with correctly identifying the parathyroid glands, precisely dissecting its envelope and protecting its blood supply. Serum calcium level and parathyroid hormone were measured before and 24 hours after operation. The patients who had symptomatic hypocalcemia or hypoparathyroidism were given supportive treatment and followed-up., Results: At least one of the parathyroid glands was preserved and remained in situ in all cases. Eighty-nine cases (8.7%) had decreased parathyroid hormone levels and 42 cases (4.1%) had complicated symptomatic hypocalcemia. The symptoms of hypocalcemia in all these cases could be controlled by supportive treatment, and serum calcium level and parathyroid hormone had all recovered 1 - 6 months later. If 3 and 4 parathyroid were conserved in situ, the postoperative complication rate was significantly lower than those with 1 and 2 parathyroid conserved (decreased PTH 69/999 vs 20/20, symptoms of hypocalcemia 25/999 vs 17/20, all P < 0.01)., Conclusion: The techniques to protect parathyroid glands in situ are effective measure to prevent the postoperative hypoparathyroidism in total thyroidectomy.