Use of sub capsular saline injection during thyroid surgery to preserveparathyroid function.

Thyroidectomy is the most common elective endocrine surgical procedures performed worldwide. Total thyroidectomy is the treatment of choice for both benign and malignant thyroid diseases. The incidence of post-operative hypocalcemia varies from 1.6 – 50% and is caused due to inadvertent removal, mechanical or thermal injury to the parathyroid glands. With improved knowledge of the variations in the position and vascular anatomy of the parathyroid glands, this has resulted in a significant reduction in the incidence of postoperative hypoparathyroidism. However, symptomatic hypocalcemia continues to be one of the leading causes of post thyroidectomy morbidity and can result in psychological and emotional disturbances, prolonged hospital stay and additional financial burden.Various procedures such as preservation of the inferior thyroid vein, parathyroid autotransplantation, and the use of angiography with indocyanine green, carbon nanoparticles, or a gamma probe to identify the parathyroid glands has been tested to reduce the frequency of hypoparathyroidism after total thyroidectomy. However, careful dissection of parathyroid gland by avoiding mechanical and thermal injury remains the mainstay to prevent postoperative hypoparathyroidism. There are only two studies which have demonstrated the efficacy of subcapsular injection of saline during thyroid surgery to reduce post-operative hypoparathyroidism, however with small sample sizes. This aim of our study is to evaluate the efficacy of subcapsular injection of saline (SCASI) during thyroid surgery to reduce post-operative hypoparathyroidism by reducing mechanical and thermal injury during dissection of the parathyroid gland compared with standard thyroidectomy.