The Effect of Parathyroid Gland Autotransplantation on Hypoparathyroidism After Thyroid Surgery for Papillary Thyroid Carcinoma

Wang, Bin; Zhu, Chunhua; Yao, Xiaoxi; Wu, Jian

doi:10.2147/cmar.s323742

Cited by 4 publications

(4 citation statements)

References 37 publications

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“…[ 3 , 6 , 13 , 18 , 19 ] There is a positive correlation between the number of autografted parathyroid glands and the rate of hypoparathyroidism; the higher the number of autografted parathyroid glands, the higher the rate of hypoparathyroidism. [ 19 , 20 ]…”

Section: Discussionmentioning

confidence: 99%

The reality of hypoparathyroidism after thyroidectomy: which risk factors are effective? Single center study

et al. 2022

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Section: Discussionmentioning

confidence: 99%

The reality of hypoparathyroidism after thyroidectomy: which risk factors are effective? Single center study

et al. 2022

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“…Intraoperative parathyroid transplantation is the main method to maintain the physiological level of PTH in patients (16). Most studies believe that parathyroid transplantation during total thyroidectomy can prevent POH to a certain extent and reduce the occurrence of permanent hypoparathyroidism (17,18). However, Matilda Annebäck et al also pointed out that parathyroid transplantation is a risk factor for permanent hypoparathyroidism in patients (OR: 1.72; 95% CI: 1.47-2.01), suggesting that surgical methods, surgeons and transplantation strategies may have an important influence on the restoration of PTH in patients (11).…”

Section: Discussionmentioning

confidence: 99%

Factors in the occurrence and restoration of hypoparathyroidism after total thyroidectomy for thyroid cancer patients with intraoperative parathyroid autotransplantation

En-jie²,

Yin³

et al. 2022

Front. Endocrinol.

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IntroductionPostoperative hypoparathyroidism (POH) is the most common and important complication for thyroid cancer patients who undergo total thyroidectomy. Intraoperative parathyroid autotransplantation has been demonstrated to be essential in maintaining functional parathyroid tissue, and it has clinical significance in identifying essential factors of serum parathyroid hormone (PTH) levels for patients with parathyroid autotransplantation. This retrospective cohort study aimed to comprehensively investigate influential factors in the occurrence and restoration of POH for patients who underwent total thyroidectomy with intraoperative parathyroid autotransplantation (TTIPA).MethodThis study was conducted in a tertiary referral hospital, with a total of 525 patients who underwent TTIPA. The postoperative serum PTH levels were collected after six months, and demographic characteristics, clinical features and associated operative information were analyzed.ResultsA total of 66.48% (349/525) of patients who underwent TTIPA were diagnosed with POH. Multivariate logistic regression indicated that Hashimoto’s thyroiditis (OR=1.93, 95% CI: 1.09-3.42), P=0.024), the number of transplanted parathyroid glands (OR=2.70, 95% CI: 1.91-3.83, P<0.001) and postoperative blood glucose levels (OR=1.36, 95% CI: 1.06-1.74, P=0.016) were risk factors for POH, and endoscopic surgery (OR=0.39, 95% CI: 0.22-0.68, P=0.001) was a protective factor for POH. Multivariate Cox regression indicated that PTG autotransplantation patients with same-side central lymph node dissection (CLND) (HR=0.50; 95% CI: 0.34-0.73, P<0.001) demonstrated a longer time for increases PTH, and female patients (HR=1.35, 95% CI: 1.00-1.81, P=0.047) were more prone to PTH increases. Additionally, PTG autotransplantation with same-side CLND (HR=0.56, 95% CI: 0.38-0.82, P=0.003) patients had a longer time to PTH restoration, and patients with endoscopic surgery (HR=1.54, 95% CI: 1.04-2.28, P=0.029) were more likely to recover within six months.ConclusionHigh postoperative fasting blood glucose levels, a large number of transplanted PTGs, open surgery and Hashimoto’s thyroiditis are risk factors for postoperative POH in TTIPA patients. Elevated PTH levels occur earlier in female patients and patients without CLND on the transplant side. PTH returns to normal earlier in patients without CLND and endoscopic surgery on the transplant side.

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“…Currently, parathyroid function after thyroid surgery is evaluated using clinical symptoms and serum PTH and calcium concentrations ( 33 ). In previous studies, the sternocleidomastoid muscle was selected as the graft site to avoid making a second surgical incision; however, this method precludes differentiating parathyroid function in the transplantation site and the preserved parathyroid glands ( 34 , 35 ). Therefore, we selected the brachioradialis in the non-dominant forearm as the graft site.…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

Wang

et al. 2022

Front. Oncol.

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PurposeThis study aimed to examine the effect of selective inferior parathyroid gland autotransplantation on central lymph node dissection(CLND) and incidence of postoperative hypoparathyroidism in patients undergoing endoscopic radical resection of thyroid carcinoma.MethodsThe data of 310 patients undergoing endoscopic radical resection of thyroid carcinoma will be retrospectively analyzed. The patients will be divided into the experimental group and the control group according to whether they combined with parathyroid autotransplantation. Statistics of the incidence rate of postoperative hypoparathyroidism, the concentration of PTH and Calcium in the systemic circulation at different time points in the two groups, the concentration of PTH in the cubital fossa vein in the transplantation region in the experimental group, and the number of central lymph nodes and positive lymph nodes dissection will be carried out.ResultsThe incidence rate of temporary and permanent hypoparathyroidism in the experimental group was 33.75% and 0.625%, respectively, and in the control group was 22% and 5%, respectively; its difference was statistically significant (X2 = 10.255, P=0.006). Parathyroid autotransplantation increased incidence of transient hypoparathyroidism (OR, 1.806; Cl, 1.088-2.998; P=0.022), and lower incidence of permanent hypoparathyroidism (OR, 0.112; Cl, 0.014-0.904; P=0.040). The diameters of thyroid cancer nodules was not associated with the occurrence of transient hypoparathyroidism (OR, 0.769; Cl, 0.467-1.265; P=0.301) or permanent hypoparathyroidism (OR, 1.434; Cl, 0.316-6.515; P=0.641). Comparison of systemic circulation PTH, between the two groups showed that the PTH of patients in the experimental group was higher than that in the control group from 1 week to 12 months after the operation, and the difference was statistically significant (P<0.05). In the experimental group, from 1 week to 12 months after surgery, PTH concentrations was significantly higher in the cubital fossa of the transplantation side than in the contralateral side, and the differences were statistically significant (P<0.05). The mean number of central lymph node dissected per patient was significantly higher in the experimental group (7.94 ± 3.03 vs. 6.99 ± 2.86; P <0.05); The mean number of positive nodes per patient was significantly higher in the experimental group (3.16 ± 1.86 vs. 2.53 ± 1.59; P <0.05).ConclusionsIn endoscopic radical resection of thyroid carcinoma, parathyroid autotransplantation is more beneficial to postoperative parathyroid glands function recovery, effectively preventing postoperative permanent hypoparathyroidism and realizing more thorough CLND.

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The Effect of Parathyroid Gland Autotransplantation on Hypoparathyroidism After Thyroid Surgery for Papillary Thyroid Carcinoma

Cited by 4 publications

References 37 publications

The reality of hypoparathyroidism after thyroidectomy: which risk factors are effective? Single center study

The reality of hypoparathyroidism after thyroidectomy: which risk factors are effective? Single center study

Factors in the occurrence and restoration of hypoparathyroidism after total thyroidectomy for thyroid cancer patients with intraoperative parathyroid autotransplantation

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

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