Elsevier

Surgery

Volume 129, Issue 3, March 2001, Pages 318-323
Surgery

Original Communications
Routine parathyroid autotransplantation during thyroidectomy,☆☆

https://doi.org/10.1067/msy.2001.111125Get rights and content

Abstract

Background. Parathyroid autotransplantation (PTHAT) during thyroidectomy has been shown to reduce the incidence of permanent hypoparathyroidism. Although selective PTHAT is most commonly adopted, the value of routine PTHAT has not been well documented. Methods. From January, 1998 to March, 1999, an operative strategy incorporating routine autotransplantation of at least 1 parathyroid gland was used during thyroidectomy. The postoperative outcome of patients (n = 118) was evaluated and compared with patients (n = 271) operated during a policy of selective PTHAT (January, 1995 to October, 1997). Results. Two or more parathyroid glands were autotransplanted in 26 patients (22%) while 92 patients (78%) received autotransplantation of 1 parathyroid gland. Postoperative hypocalcemia occurred in 29 patients (25%) and 2 patients (1.7%) had permanent hypocalcemia develop. When a policy of selective PTHAT was adopted, 98 patients (36%) underwent PTHAT, and 5 patients developed permanent hypocalcemia (1.8%). The incidence of postoperative hypocalcemia was higher in patients who underwent routine PTHAT (25%) compared with that in patients who underwent selective PTHAT (15%) (P =.014). In addition, the operating time was significantly longer when routine PTHAT was adopted (153 minutes vs 130 minutes; P <.001). Conclusions. A low incidence of permanent hypoparathyroidism can be achieved by either routine or selective PTHAT during thyroidectomy but routine PTHAT is associated with a high incidence of postoperative hypocalcemia. (Surgery 2001;129:318-23.)

Section snippets

Materials and methods

From January 1998 to March 1999, there were 118 patients who underwent bilateral or completion thyroidectomies, who were at risk of postoperative hypocalcemia, and who underwent routine autotransplantation of at least 1 parathyroid gland during thyroidectomy by a single surgeon or surgical residents operating with supervision. Identification of all parathyroid glands was attempted to facilitate preservation, but excessive dissection to look for missing glands was avoided if at least 1

Results

There were 20 men and 98 women whose ages ranged from 16 to 82 years (median, 45 years). Operative procedures included total thyroidectomy (n = 49), near total (n = 10), completion total (n = 8), bilateral subtotal (n = 26), and ipsilateral total with contralateral subtotal (n = 25) thyroidectomies. Thyroid re-operations were performed in 11 patients (9.3%). The indications for operation included nodular hyperplasia (n = 54), Graves' disease (n = 31), papillary carcinoma (n = 26), follicular

Discussion

The practice of implanting parathyroid tissue has a long surgical tradition but the indication of PTHAT has recently been extended to radical head and neck operations, including total thyroidectomy.8 In fact, the biochemical function of parathyroid graft can be demonstrated after autotransplantation of normal parathyroid gland to the forearm23 and during long-term follow-up.17 In adopting a surgical technique using PTHAT, an operative strategy combining preservation of parathyroid in situ with

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  • Cited by (0)

    Reprint requests: Dr Chung Yau Lo, Division of Endocrine Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong, China.

    ☆☆

    Surgery 2001;129:318-23.

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