Current status of parathyroid autotransplantation

Abstract

Autotransplantation of the parathyroid glands is a clinically useful modality for the management of patients with certain forms of hyperparathyroidism. In conjunction with total parathyroidectomy, this procedure has been used to treat patients with primary and secondary hyperparathyroidism who have generalized parathyroid hyperplasia. Parathyroid autotransplantation is also an important adjunct to the management of patients undergoing radical thyroid or laryngeal surgery to prevent permanent hypoparathyroidism from devascularization of all in situ parathyroid tissue. The technique of parathyroid cryopreservation has been well established and provides surgeons with greater flexibility in the approach to patients undergoing reoperative parathyroid surgery in whom there is uncertainty about the functional status of the remaining parathyroid tissue. Parathyroid allotransplantation has been successfully performed in immunosuppressed patients but is rarely indicated. Parathyroid autografts can be placed heterotopically in a forearm muscle or in the sternocleidomastoid, but the former site is preferred in patients with hyperplastic or adenomatous tissue. This technique results in a low incidence of permanent hypoparathyroidism after radical parathyroidectomy, and recurrent hypercalcemia can be easily managed by local excision of a portion of the grafted tissue.

Simultaneous Kidney and Parathyroid Transplantation in the Management of Genetic Hypoparathyroidism in a Child

“…5,15,16 Parathyroid autografts are typically placed heterotopically into a forearm or sternocleidomastoid muscle. This technique results in a low incidence of permanent hypoparathyroidism following radical parathyroidectomy, and recurrent hypercalcemia can be easily managed by local excision of a portion of the grafted tissue 17 if it becomes necessary. However, when parathyroid tissue is transplanted into an arm, there can be differences in PTH levels depending on which side the blood is drawn.…”

Parathyroid Auto-transplantation Mimicking Liposarcoma

“…Implantation of parathyroid tissue into the forearm after a total parathyroidectomy or thyroidectomy is well described [1-3]. Although the sternocleidomastoid muscle is the preferred location for autotransplantation, the forearm serves as a useful reservoir due to our ability to remove the graft if needed [2].…”

“…Although the sternocleidomastoid muscle is the preferred location for autotransplantation, the forearm serves as a useful reservoir due to our ability to remove the graft if needed [2]. After parathyroid tissue is removed, intraoperative parathyroid hormone levels are checked to ensure a decline and part of the tissue is subsequently either cryopreserved or immediately autotransplanted [1]. Imaging of the autotransplanted tissue is typically not done, and no research exists on how parathyroid tissue in the forearm appears on a computed tomography (CT) scan.…”