Subcapsular Saline Injection vs. Direct Visualization Method to Save Parathyroid Gland During Thyroidectomy; Comparative Study

Sunday, October 12, 2025

8:12 AM - 8:18 AM EDT

Location: 127

Disclosure(s):

Ainulakbar Mughal, MBBS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Mohammad Sohail Awan, MBBS; FCPS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The parathyroid glands are at risk during thyroidectomy, with hypocalcemia being a common complication. While direct visualization is widely used to preserve parathyroid glands and their blood supply, subcapsular saline injection (SCASI) is claimed to have superior outcomes in maintaining blood supply and in situ gland preservation.

Methods: A total of 200 patients who underwent thyroidectomy in our hospital for thyroid malignancies or benign disorders from January 2023 to April 2024 were selected and divided into the subcapsular saline injection (SCASI) group (n = 107 ) and non SCASI - the direct visualization method (DVM) group (n = 93). The general clinical data of the patients were collected, and serum calcium levels were determined preoperatively, on the postoperative day 1, 10 and 30 to compare incidence of hypocalcemia post operatively. These data were compared between groups.

Results: A total of 200 patients were divided into two groups: the SCASI group consisted of 107 patients (5 men, 102 women) with a mean age of 47.28 ± 12.18 years, while the DVM group consisted of 93 patients (27 men, 66 women) with a mean age of 46.33 ± 14.91 years. There was no significant difference in age, sex, comorbidities, pathological classification, albumin levels or preoperative calcium levels.
The mean serum calcium levels on postoperative day 1 were significantly higher in the SCASI group compared to the DVM group (8.79 ± 0.80 vs. 7.75 ± 0.80; p < 0.001). Similarly, at one month postoperatively, the SCASI group exhibited significantly higher mean serum calcium levels compared to the DVM group (8.90 ± 0.53 vs. 8.25 ± 0.66; p < 0.001).
moreover, patients who underwent the SCASI method experienced significantly lower rates of transient hypocalcemia compared to DVM patients (8.4% vs. 51.6%; P < 0.001). Similarly, the incidence of permanent hypocalcemia was significantly lower in the SCASI group (3.7% vs. 18.3%; P < 0.001).

Conclusions: Subcapsular Saline infiltration method is a quick and easy method to save parathyroid glands during thyroidectomy. It reduces the rate of transient and permanent hypocalcemia post thyroidectomy.

Presenting Author(s)

AM

Ainulakbar Mughal, MBBS

Fellow
Aga Khan University Hospital
Karachi, Sindh, Pakistan

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Mohammad Sohail Awan, MBBS; FCPS

Associate Professor
Aga Khan University Hospital
Karachi, Sindh, Pakistan

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

AM

Ainulakbar Mughal, MBBS

Fellow
Aga Khan University Hospital
Karachi, Sindh, Pakistan

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Shabbir Akhtar, FCPS

Associate Professor
Aga Khan University Hospital
Karachi, Sindh, Pakistan

Disclosure information not submitted.

Senior Author(s)

Shabbir Akhtar, FCPS

Associate Professor
Aga Khan University Hospital
Karachi, Sindh, Pakistan

Disclosure information not submitted.

Co-Author(s)

AJ

Azma Jahangir, MBBS

Aga Khan University Hospital, United States

Disclosure information not submitted.
HP

Hamdan Pasha, MD

Aga Khan University Hospital, Sindh, Pakistan

Disclosure information not submitted.
SS

Saadia Sattar, MSc

Aga Khan University Hospital, Sindh, Pakistan

Disclosure information not submitted.
Mohammad Sohail Awan, MBBS; FCPS

Associate Professor
Aga Khan University Hospital
Karachi, Sindh, Pakistan

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.