Selective Parathyroid Autotransplantation During Total Thyroidectomy for Papillary Thyroid Carcinoma: A Cohort Study

Abstract

Purpose: The relationship between the selective parathyroid gland (PG) autotransplantation and hypoparathyroidism is still not completely clear. The aim was to ascertain whether the number of autotransplanted PGs affected the incidence of hypoparathyroidism and recovery of parathyroid function in the long-term for patients with papillary thyroid carcinoma (PTC).Methods: A retrospective cohort study included all patients with PTC who had underwent primary total thyroidectomy with central neck dissection between January 2013 and December 2017. The patients were divided into three groups (0, 1, and 2 PGs autotransplanted, respectively).Results: Of the 2,477 patients, 634 (25.6%) received no PG autotransplantation, 1,078 (43.5%) and 765 (30.9%) were autotransplanted 1 and 2 PGs, respectively, and the incidence of permanent hypoparathyroidism (>1 year) was 1.7%, 0.7%, and 0.4% (P = 0.0228). Both 1 or 2 PGs autotransplanted increased the incidence of transient biochemical hypoparathyroidism (odds ratio [OR], 1.567; 95% confidence interval [CI], 1.258–1.953; P < 0.0001; OR, 2.983; 95% CI, 2.336–3.810; P < 0.0001, respectively) but reduced the incidence of permanent hypoparathyroidism (OR, 0.373; 95% CI, 0.145–0.958; P = 0.0404; OR, 0.144; 95% CI, 0.037–0.560; P = 0.0052, respectively). Both 1 or 2 PGs autotransplanted did not independently influence the occurrence of hypocalcemia symptoms.Conclusion: Selective parathyroid autotransplantation is less likely to lead to post-operative symptomatic hypocalcemia, although it could lead to a transient decrease in parathyroid hormone. However, in the long run, it is still an effective strategy to preserve parathyroid function.

Clinical application of parathyroid autotransplantation in endoscopic radical resection of thyroid carcinoma

“…Selective parathyroid autotransplantation during endoscopic radical resection of thyroid carcinoma is effective in preventing permanent hypoparathyroidism. This is consistent with the findings of Qiu’s ( 31 ) study. At the same time, we found that the diameters of thyroid cancer nodules was not associated with the occurrence of transient hypoparathyroidism or permanent hypoparathyroidism which was the same conclusion as Yazıcıoğlu et al ( 22 ).…”

“…Qiu et al. ( 31 ) concluded that parathyroid autotransplantation is an independent risk factor for transient hypoparathyroidism but a preventive factor for permanent hypoparathyroidism and recommended selective parathyroid autotransplantation. Su et al.…”

“…Ahmed et al (30) proposed that autologous parathyroid transplantation is the preferred method to ensure good parathyroid function and recommended routine transplantation. Qiu et al (31) concluded that parathyroid autotransplantation is an independent risk factor for transient hypoparathyroidism but a preventive factor for permanent hypoparathyroidism and recommended selective parathyroid autotransplantation. Su et al (32) found that parathyroid autotransplantation during thyroidectomy was not associated with the development of permanent postoperative hypoparathyroidism, so it is recommended that parathyroid glands be preserved in situ whenever possible.…”

A modified, single-incision, gasless, endoscopic thyroidectomy and bilateral central neck dissection via axillary approach technique for bilateral papillary thyroid microcarcinoma: A preliminary report

“…Thus, the magnified view in endoscopy offered us the chance to distinguish and preserved the vessels of the PTGs [ 21 ]. Some of the studies have shown that if the PTGs cannot be preserved in situ , autotransplantation is recommended for suspicious PTGs confirmed by an intraoperative frozen section and this procedure will not increase the complication rates of permanent hypocalcemia [ 22 , 23 ]. The major and minor complication rates were not higher than those in other reports [ 19 ], indicating the safety and feasibility of the modified approach.…”

Correlation between parathyroid function and serum levels of 1,25(OH)2D3, serum phosphorus, and parathyroid hormone after surgery for papillary thyroid carcinoma

“…Its sensitivity and specificity reached 100% and 80.4% respectively, while the latter reached 94.7% and 84.8% respectively. The decrease of iPTH can be regarded as an important technical index reflecting the damage of PTF during surgery, which can effectively predict early postoperative hypocalcemia and is closely related to persistent HPT (20). However, whether perioperative vitamin D deficiency increases the risk of postoperative PTF reduction remains controversial.…”