Endocrine Abstracts

Topicality: The most common cancer of the endocrine system is thyroid cancer. The main method of treatment for highly differentiated thyroid cancer is surgical.

A special place among the complications of surgical treatment of thyroid cancer according to the severity of manifestation and the complexity of prevention is occupied by postoperative hypoparathyroidism.

The purpose of the study.

Minimize the risk of damage to the parathyroid glands during thyroid surgery.

Inclusion criteria – patients with highly differentiated thyroid cancer T1-4aN1a-1bM0-1.

Exclusion criteria – highly differentiated thyroid cancer T1-2N0M0patients.

Materials and methods: The object of the study was 163 patients with highly differentiated thyroid cancer treated in the Samara Regional Clinical Oncology Center from July 2017 to September 2019. The average age of patients in the main group (thyroidectomy + selective cervical dissection using the pharmaceutical preparation 5-aminolevulinic acid hydrochloride) was 68.5 ± 25.6 years (18–82), 84 patients in total, in the control group (thyroidectomy + selective cervical dissection)) – 64.9 ± 24.5 years (21–78) of a total of 79 patients. In order to evaluate the effectiveness of parathyroid gland preservation, the level of parathyroid hormone was monitored on days 7, 25–30 and 55–60 after surgery and calcium, ionized calcium, phosphorus on 1, 7, 25–30, 55–60 days after surgery. Patients of the main group in the preoperative period were orally prescribed to take the 5-aminolevulinic acid hydrochloride drug twice – 3 hours before the start of surgery at a dose of 20 mg/kg (180 ± 15 min), then – 1 hour before surgery at a dose of 10 mg/kg (60 ± 10 min). Intraoperatively, to detect the parathyroid glands, an optical radiation source with a wavelength in the range from 385 to 460 nm and polarizing glasses were used, when fluorescent sites were detected, an urgent cytological study was performed to confirm parathyroid gland visualization.

Results: In the main group, transient hyperparathyroidism was observed in 2 patients (2.3%), stopped in 7 days. Persistent hypoparathyroidism was absent in patients of the main group. In the control group, transient hypoparathyroidism wasobserved in 12 patients (15.1%). Persistent hypoparathyroidism was observed in 2 patients (2.5%) in the control group.

Conclusions: Intraoperative navigation of the parathyroid glands using the pharmaceutical preparation 5-aminolevulinic acid hydrochloride can significantly reduce the number of postoperative complications associated with the removal/damage of the parathyroid glands.