Parathyroid autotransplantation during thyroid surgery

Abstract

Permanent hypoparathyroidism is one of the most distressing complications of thyroid surgery. The incidence of this iatrogenic complication varies between 3 and 25 percent among patients undergoing total thyroidectomy. Parathyroid injury may be caused by inadvertent removal of the parathyroids, ligation of the blood supply, or destruction secondary to capsular hematoma. Attention to such technical details as identification of the parathyroids, dissection close to the thyroid gland, preservation of the blood supply to the parathyroids, and avoiding manipulation of parathyroids reduces the incidence of temporary and permanent hypoparathyrodism. However, if the parathyroids are injured, the best method of preserving their function is by autotransplantation. Over the past 7 years we have performed 250 thyroidectomies. An attempt was made to identify and preserve parathyroid gland in each case. Even during lobectomy procedures, the ipsilateral parathyroids were identified and preserved. Whenever any of the parathyroids was devascularized or separated from the surrounding structures, it was autotransplanted into the sternomastoid muscle. The sternomastoid was chosen for autotransplantation rather than forearm muscles to avoid an added incision and because selective measurement of parathormone is not essential in this group of patients. Prior to autotransplantation, confirmation of the nature of the tissue was made by frozen section of a small portion of the parathyroid gland. Parathyroid autotransplantation was performed in 15 instances, even when only one parathyroid was injured. Only one member of this group of 15 patients developed temporary hypoparathyroidism, which disappeared after 4 weeks of calcium supplementation. The remaining patients had an uncomplicated recovery. Autotransplantation of the parathyroid glands should be performed whenever the parathyroid is devascularized or damaged by retraction or hematoma. It is essential for every thyroid surgeon to be familiar with the technique of parathyroid autotransplantation.

Hypocalcaemic Tetany After Total Thyroidectomy

“…This picture is consistent with other acceptable publications 9 . In one study 'parathyroid autotransplantation during thyroid surgery' Department of Surgery, SUNY Health Science Centre at Brooklyn, New York showed the incidence of permanent hypocalcaemia with hypoparathyroidism following total thyroidectomy varied from 3-25% 10 .…”

Use of prophylactic oral calcium after total thyroidectomy: a prospective study

“…Sandström suggested the name of the parathyroid gland while recognizing the independence of its anatomic structure in relation to the thyroid gland. The association between the parathyroid glands and tetany was recognized after 1890 according to Thompson (26) and as cited by Hojaij (5 (36) to suggest a meticulous examination of the surgical specimen for identification of parathyroid glands potentially removed during surgery, with the intention of surgically reimplanting them. Careful dissection, preservation of the parathyroid glands, and peripheral vascular ligation of the thyroid arteries with minimum damage to the parathyroid irrigation, associated with preservation and eventual parathyroid reimplantation, remain today as time-honored surgical procedures to prevent hypoparathyroidism after thyroid surgery.…”

Identification of patients at high risk for hypocalcemia after total thyroidectomy with serial calcium estimation and intact parathyroid hormone levels-a comparative study

“…6,7 Different groups have published considerable research on this topic, demonstrating that 1 and 6-hour postoperative PTH and Calcium levels had a high sensitivity and specificity of detecting postoperative hypocalcaemia. [8][9][10] The purpose of this study is to determine the number of high-risk patients who develop hypocalcaemia after total thyroidectomy by serial calcium level estimation in 6 hours, 24 hours, 48 hours and 2 weeks of post-operative period and post-operative intact parathyroid hormone (i PTH) level estimation and comparing predictive value in permanent hypocalcaemia.…”