Intra- and Postoperative Parathyroid Hormone-Kinetics Do Not Advocate for Autotransplantation of Discolored Parathyroid Glands During Thyroidectomy

Abstract

The function of discolored PGs is only transiently impaired and recovers within a short time after surgery. Our observations do not support autotransplantation as a generally applicable first-line intervention for discolored PGs in the absence of other criteria for autotransplantation.

Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery

“…As suggested by other authors5, 25, visual evaluation of the parathyroid gland is not a reliable predictor of good postoperative parathyroid function after thyroid surgery.…”

“…It has been generally accepted that half of one normal parathyroid gland can produce sufficient parathyroid hormone (PTH)2, 3. To avoid postoperative hypocalcaemia, parathyroid autotransplantation can be performed, although the results have been controversial4, 5.…”

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

“…A prospective study of total or near-total thyroidectomy patients with 3 or 4 discolored parathyroid glands of the 4 visually identified parathyroid glands demonstrated only transiently impaired parathyroid function such that autotransplantation of discolored parathyroid glands was not recommended in the absence of other criteria for autotransplantation (17). If the anatomic location of an identified parathyroid gland does not allow for preservation with its vascular pedicle intact during thyroidectomy or the parathyroid gland develops visible evidence of venous congestion or ischemia, then the parathyroid gland is placed in sterile iced saline.…”

A reappraisal of vascular anatomy of the parathyroid gland based on fluorescence techniques

“…It is generally accepted that sufficient parathyroid hormone (PTH) can be produced by one half of a normal PG (6). To avoid postoperative hypocalcemia, parathyroid autotransplantation can be performed; however, the results have been inconsistent, creating controversy (15)(16)(17). Therefore, capsular dissection techniques and preservation of the surrounding vasculature have been proposed and utilized, in an attempt to avoid inadvertent parathyroidectomy or the disruption of the parathyroid vasculature (18)(19)(20).…”