Parathyroid Autotransplantation during Total Thyroidectomy—Does the Number of Glands Transplanted Affect Outcome?

Abstract

Parathyroid autotransplantation is a technique for ensuring the continued function of parathyroid tissue at the time of total thyroidectomy (TT). The aim of this study was to ascertain whether the number of parathyroids transplanted affects the incidence of temporary and permanent hypoparathyroidism. A retrospective cohort study included all patients undergoing a TT in a single unit between July 1998 and June 2003. The number of parathyroids transplanted, the final pathology, and the incidence of temporary and permanent hypoparathyroidism were documented. Fisher's exact test was used for statistical analysis. A total of 1196 patients underwent a TT during the 5 years studied. Of these, 306 (25.6%) had no parathyroids transplanted, 650 (54.3%), 206 (17.2%), 34 (2.8%) had 1,2, or 3 glands autotransplanted, respectively. The incidence of temporary hypoparathyroidism was 9.8% for no gland transplants, 11.9%, 15.1%, and 31.4% for 1,2,and 3 gland transplants, respectively (p < 0.05). The incidence of permanent hypoparathyroidism was 0.98%, 0.77%, 0.97%, and 0%, respectively (p = NS). The incidence of temporary hypoparathyroidism was higher when surgery was performed for Graves' disease. Temporary hypocalcemia is closely related to the number of autotransplanted parathyroids during TT. The long-term outcome is not affected by the number of parathyroids autotransplanted. A "ready selective" approach to parathyroid autotransplantation is an effective strategy for minimizing the rate of permanent hypoparathyroidism.

American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: Postoperative Hypoparathyroidism - Definitions and Management

“…A large retrospective study comparing the occurrence of hypoparathyroidism after autotransplantation of 0, 1, 2, or 3 parathyroid glands following total thyroidectomy found 9.8%, 11.9%, 15.1%, and 31.4% (P<.05) incidence rates of temporary hypoparathyroidism respectively; the corresponding rates for permanent hypoparathyroidism were 0.98%, 0.77%, 0.97%, and 0% (P>.05) (19). The principal value of parathyroid autotransplantation is in the prevention of permanent hypoparathyroidism.…”

The risk of hypocalcemia in patients with parathyroid autotransplantation during thyroidectomy

“…Evaluation of the blood supply to the parathyroid capsule by making an incision, examination of blood flow by Doppler ultrasound, and intraoperative PTH measurements are within recommended methods in this regard. However, an ideal marker has not yet been identified (16). Therefore, parathyroid autotransplantation has been recommended whenever the function of the parathyroid gland is suspicious.…”

“…Kihara found the rate of permanent hypoparathyroidism in patients with autotransplantation as 21%, and reported that the PTH levels fall to 50% of the preoperative value in 5-year long-term follow-up. It is also noted that the routine practice of autotransplantation increases the rate of transient hypocalcemia in several studies (16,26). However, there is no agreement in the literature on this subject.…”

“…Palazzo et al (16) reported that as the number of autotransplanted parathyroid glands increase the transient hypocalcemia rate also increased and they described the selective approach in PA rather than routine autotransplantation of well-vascularized parathyroid glands. In this approach, the threshold for selective treatment is low, autotransplantation of the parathyroid gland that is considered to have a minor change in its pedicle and vascular supply is encouraged.…”

Influence of magnesium sulphate infusion before total thyroidectomy on transient hypocalcemia — a randomised study

“…9,14,15 Some parathyroid glands may be anatomically intact; however, their function may nevertheless be physiologically impaired because of parathyroid arteria occlusion or edematous gland. 16,17 Intraoperative change of the colour of parathyroid is believed to be an indicator of insufficient blood supply; however, Ander et al proved that the disorders in the microcirculation of parathyroid glands are not related to their macroscopic appearance. 18 We claim that, in our case, the experience of the surgeon could not significantly affect the outcome of surgery because both surgeons applied similar surgical procedures and were also equally skilled.…”