Inadvertent parathyroidectomy during thyroid surgery: Incidence, risk factors, and clinical significance
In brief
14% of thyroidectomy patients had inadvertent parathyroid removal; neck dissection linked to 4-fold odds
In this retrospective study at one high-volume center, pathology showed inadvertent parathyroid removal in about 1 in 7 of 830 thyroidectomy patients. Central neck dissection was associated with more than four times the odds, while several other factors were linked to lower odds; whether targeted surgical strategies reduce this complication remains unknown.
- Journal
- Surgery (Q1)
- Published
- 3 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- James Stathakios, Tiffany A Johnson, Dharmindra Dulal, Andrew Boring, Avish S Persaud, Meghan Barber, et al.
- PMID
- 42786092
- DOI
- 10.1016/j.surg.2026.110613
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (paper of the day, 26 September 2026): Inadvertent parathyroidectomy common, risk factors identified, surgical mitigation needed
Abstract
BACKGROUND: Inadvertent parathyroidectomy is a well-recognized complication of thyroid surgery, which is associated with postoperative hypoparathyroidism and hypocalcemia. Reported incidence rates of inadvertent parathyroidectomy vary widely in the existing literature, and patient- and procedure-specific risk factors remain incompletely defined. This study analyzes the incidence and risk factors associated with inadvertent parathyroidectomy during thyroidectomy. METHODS: We conducted a retrospective cohort study of 830 patients who underwent thyroidectomy at a single high-volume endocrine surgery center from 2016 to 2022. The primary outcome was the occurrence of inadvertent parathyroidectomy, which was obtained from final surgical pathology reports. Multivariable analysis using logistic regression was performed to assess adjusted outcomes. RESULTS: Among 830 patients, the overall incidence of inadvertent parathyroidectomy was 13.5%. After adjustment, thyroidectomy with central neck dissection (adjusted odds ratio, 4.35; 95% confidence interval, 2.29-8.24) was independently predictive of inadvertent parathyroidectomy, whereas age >65 years (adjusted odds ratio, 0.59; 95% confidence interval, 0.36-0.99), goiter (adjusted odds ratio 0.76; 95% confidence interval, 0.60-0.95), and total thyroidectomy (adjusted odds ratio, 0.41; 95% confidence interval, 0.28-0.59) were associated with lower odds of inadvertent parathyroidectomy. Gender, malignancy, specimen weight, operative time, and prior neck surgery were not associated with inadvertent parathyroidectomy. CONCLUSION: Inadvertent parathyroidectomy is common following thyroidectomy and is associated with select patient- and procedure-related factors. Recognition of high-risk cases may support targeted intraoperative mitigation strategies to improve parathyroid identification and preservation, including autotransplantation when in situ preservation is not feasible. Future efforts should focus on investigation of emerging strategies, such as indocyanine green fluorescence imaging and near-infrared autofluorescence, to enhance intraoperative parathyroid identification and preservation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.