Parathyroid autotransplantation with total thyroidectomy for thyroid carcinoma: Long-term follow-up of grafted parathyroid function

Kikumori, Toyone; Imai, Tsuneo; Tanaka, Yuji; Oiwa, Mikinao; Mase, T.; Funahashi, Hiroomi

doi:10.1016/s0039-6060(99)70201-1

Cited by 57 publications

(41 citation statements)

References 8 publications

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“…The recovery ratio of intact PTH levels on POD 360 to the preoperative level was significantly lower in group III than that in groups I or II (**P Ͻ 0.01) mean period of 34 months, the I-PTH levels from 1 month to several years postoperatively remained relatively constant, but did not recover to preoperative levels. 18 In our study, the mean 1-year postoperative recovery for the autotransplantation group was 43% of the preoperative levels, while that for four transplanted glands was 70% of the preoperative I-PTH levels. These results imply that parathyroid gland activity cannot be expected to recover to the preoperative levels in patients who undergo autotransplantation only.…”

Section: Discussionmentioning

confidence: 44%

Recovery of Parathyroid Function After Total Thyroidectomy

et al. 2000

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To prevent postoperative hypoparathyroidism following total thyroidectomy, the parathyroid glands are preserved in situ and/or resected or devascularized parathyroid glands are autotransplanted. We conducted a retrospective investigation utilizing biochemical and specific endocrine assessments to evaluate the difference in recovery of parathyroid function between the two operative methods. A total of 92 patients underwent total thyroidectomy at our hospital during the period between 1990 and 1997. These patients were divided into a preservation group (n = 83), with one or more preserved glands in situ, and an autotransplantation group (n = 9), with only transplanted glands. The level of intact parathyroid hormone (PTH) was completely restored by 1 year postoperatively in 83% (69/83) of the preservation group patients. In the remaining 14 patients (17%), the intact PTH had fallen below detectable levels on postoperative day (POD) 1, then subsequently recovered to 70% of the preoperative levels. Comparatively, in the autotransplantation group, the mean level of intact PTH recovered to only 43% of the preoperative levels. The results of this study suggest that parathyroid glands should be preserved in situ whenever possible, and that when intact PTH levels fall below detectable limits on POD 1, they may never recover to the preoperative levels in those patients.

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Section: Discussionmentioning

confidence: 44%

Recovery of Parathyroid Function After Total Thyroidectomy

et al. 2000

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“…This would justify autotransplantation of accidentally extirpated PGs [6, 28, 29]. In the present series, more than half of IPTs could theoretically have been avoided, since the PGs were found in extra- and subcapsular locations.…”

Section: Discussionmentioning

confidence: 85%

Incidental Parathyroidectomy during Total Thyroidectomy: Risk Factors and Consequences

Manatakis

Balalis

Soulou

et al. 2016

International Journal of Endocrinology

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Objective. To evaluate the incidence of accidental parathyroidectomy in our series of total thyroidectomies, to investigate its clinical and biochemical consequences, and to identify potential risk factors. Methods. Patients who underwent total thyroidectomy between January 2006 and December 2015 were retrospectively analyzed. Pathology reports were reviewed to identify those cases who had an incidental parathyroidectomy and these were compared to patients with no parathyroidectomy, in terms of clinical (age, sex, and symptoms of hypocalcemia), pathological (thyroid specimen weight, Hashimoto thyroiditis, and malignancy), and biochemical (serum calcium and phosphate levels) factors. Results. 281 patients underwent total thyroidectomy during the study period. Incidental parathyroidectomy was noticed in 24.9% of cases, with 44.3% of parathyroid glands found in an intrathyroidal location. Evidence of postoperative biochemical hypocalcemia was noticed in 28.6% of patients with parathyroidectomy, compared with 13.3% in the no-parathyroidectomy group (p = 0.003). Symptomatic hypocalcemia was observed in 5.7% and 3.8%, respectively (p = 0.49). Age, sex, thyroid specimen weight, Hashimoto thyroiditis, and malignancy did not differ significantly between the two groups. Conclusions. Our study found an association of incidental parathyroidectomy with transient postoperative biochemical hypocalcemia, but not with clinically symptomatic disease. Age, sex, thyroid gland weight, Hashimoto thyroiditis, and malignancy were not identified as risk factors.

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“…Although the standard surgical procedure includes methods that aim to preserve the vascular structure of the parathyroid gland, the methods remain difficult despite the fact that the anatomic vascular structure surrounding the thyroid and parathyroid glands is now well known. Therefore, some surgeons prefer to implant the parathyroid glands in the sternocleidomastoid muscle or mince the glands into 1‐mm by 1‐mm pieces and inject them into the forearm when they see the parathyroid glands darkening after removal of the thyroid (due to devascularization), or when they inadvertently excise the parathyroid glands . The implanted and injected glands function in 87.1% and 69% of cases .…”

Section: Discussionmentioning

confidence: 99%