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Failure of fragmented parathyroid gland autotransplantation to prevent permanent hypoparathyroidism after total thyroidectomy

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Abstract

Purpose

Parathyroid autotransplantation during total thyroidectomy leads to higher rates of postoperative hypocalcaemia. It has been argued, however, that it prevents permanent hypoparathyroidism. The impact of autografted normal parathyroid gland fragments on long-term parathyroid status has not been assessed properly. To clarify this, the short- and long-term parathyroid function was assessed in patients with three glands remaining in situ after total thyroidectomy, in whom the fourth gland was either autotransplanted (Tx) or accidentally resected (AR).

Methods

Consecutive patients (n = 669) undergoing first-time total thyroidectomy were prospectively studied recording the number of parathyroid glands remaining in situ: PGRIS =4—(glands autografted + glands in the specimen). The study was focused on the subgroup of 186 patients with three parathyroid glands remaining in situ as a result of either accidental resection (AR, n = 76) or autotransplantation into the sternocleidomastoid muscle (Tx, n = 110). Prevalence of postoperative hypocalcaemia, protracted, and permanent hypoparathyroidism were compared between the two groups. Demographic, disease-related, laboratory, and surgical variables were recorded. All patients were followed for at least 1 year.

Results

Both groups were comparable in terms of disease and extent of surgery. Mean postoperative serum calcium was the same (AR: 1.97 ± 0.2 vs Tx: 1.97 ± 0.22 mmol/L). Rates of protracted (AR: 24% vs Tx: 25.5%) and permanent hypoparathyroidism (AR: 5.3% vs Tx: 7.3%) were similar in both groups.

Conclusions

The prevalence of parathyroid failure syndromes after total thyroidectomy was similar whether a parathyroid gland was inadvertently excised or autotransplanted. Autotransplantation did not influence the permanent hypoparathyroidism rate.

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Acknowledgements

No sources of funding for the work have been reported.

Authors’ contributions

(1) Conception and design: Leyre Lorente-Poch, MD, Juan José Sancho, MD, and Antonio Sitges-Serra, MD, FRCS; (2) administrative support: none; (3) provision of study materials or patients: Leyre Lorente-Poch, MD, Carlos Martínez-Ruiz, MD, Lander Gallego-Otaegui; (4) collection and assembly of data: Leyre Lorente-Poch, MD, Carlos Martínez-Ruiz, MD, Lander Gallego-Otaegui; (5) data analysis and interpretation: Juan José Sancho, MD, Antonio Sitges-Serra, MD, FRCS; (6) manuscript writing: Leyre Lorente-Poch, MD, Juan José Sancho, MD, Jose Luis Muñoz, MD, and Antonio Sitges-Serra, MD, FRCS; (7) final approval of manuscript: all authors.

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Authors and Affiliations

  1. Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25–29, 08003, Barcelona, Spain

    Leyre Lorente-Poch, Juan Sancho, Jose Luis Muñoz, Lander Gallego-Otaegui, Carlos Martínez-Ruiz & Antonio Sitges-Serra

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  1. Leyre Lorente-Poch
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  2. Juan Sancho
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Correspondence to Antonio Sitges-Serra.

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The authors declare that they have no conflict of interest.

Ethical considerations

The authors of the present study state that the protocol for the research project has been approved by a suitably constituted Ethics Committee of the Hospital del Mar within which the work was undertaken and that it conforms to the provisions of in accordance with the Helsinki Declaration as revised in 2013. The study outcomes will affect the future management of our patients since the use of parathyroid autotransplantation will become restrictive.

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Lorente-Poch, L., Sancho, J., Muñoz, J.L. et al. Failure of fragmented parathyroid gland autotransplantation to prevent permanent hypoparathyroidism after total thyroidectomy. Langenbecks Arch Surg 402, 281–287 (2017). https://doi.org/10.1007/s00423-016-1548-3

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