Mellanby Centre for Bone Research Seminar

Parathyroid preservation – the holy grail of thyroid surgery

Dr Sabapathy Balasubramanian, Department of Oncology & Metabolism, University of Sheffield

Friday 12 April 2019, 1.00 -2.00 pm, Lecture Theatre 3, F Floor, The Medical School

Abstract

Post-surgical hypoparathyroidism (PoSH) is the most common type of parathyroid insufficiency and is largely caused by thyroid surgery. PoSH has a prevalence of around 22/100,000 in the western world and is rising in parallel with the number of thyroid operations performed worldwide. PoSH has a significant long term morbidity and mortality.

Efforts are underway to understand the underlying mechanisms and long term morbidity of PoSH and develop methods to reduce its occurrence after surgery.

Traditional surgical techniques to improve parathyroid identification and preservation during thyroidectomy have not made a significant impact on PoSH rates. A number of novel approaches using technology that exploit unique features of parathyroid tissue are being developed to aid the surgeon in parathyroid preservation. These technologies include fluorescent imaging, impedance spectroscopy and confocal imaging.

I will summarise our efforts in addressing the problem of PoSH and in developing some of these technologies for clinical use in patients at risk of developing post-surgical hypoparathyroidism.

Are we getting close to reducing PoSH rates to negligible levels or will parathyroid damage continue to plague patients and frustrate thyroid surgeons for decades to come?

Biography – Saba Balasubramanian is an endocrine surgeon and clinical lead for endocrine surgery in Sheffield Teaching Hospitals and educational lead for the British Association of Endocrine and Thyroid surgeons. In addition to numerous book chapters, he has published in peer reviewed journals on thyroid, parathyroid, adrenal surgery and breast cancer and is a chief investigator on several translational and clinical research projects. His current research interests include post surgical hypoparathyroidism (PoSH) and thyroid cancer epidemiology.

Saba has published observational studies and systematic reviews on the incidence, risk factors and prevention of PoSH and is working on novel ways to reduce the risk of PoSH. He has conducted animal and early phase I studies of near infra-red fluorescent imaging and electrical impedance spectroscopy to aid parathyroid identification and has recently been awarded a NIHR EME grant to run a multicicentre trial on fluorescent imaging of parathyroids (the NIFTy – Near Infra Red Fluorescent Imaging in Thyroid surgery – trial).