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.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Total thyroidectomy: the treatment of choice for patients with differentiated thyroid cancer.Ann Surg. 1982; 196: 361-370
- Early postoperative morbidity after surgical treatment of thyroid carcinoma.Surgery. 1986; 101: 224-227
- Total thyroidectomy: complications and technique.World J Surg. 1986; 10: 781-786
- Complications of thyroid surgery.Ann Surg Oncol. 1995; 2: 56-60
- Surgical management of papillary and follicular carcinoma of thyroid.Ann Surg. 1980; 192: 701-704
- Post-thyroidectomy hypocalcemia.Am J Surg. 1986; 152: 606-610
- Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system.Surgery. 1987; 102: 1088-1095
- Parathyroid autotransplantation during thyroidectomy. Results of long-term follow-up.Ann Surg. 1996; 223: 472-480
- Postoperative hypocalcemia in patients who did or did not undergo parathyroid autotransplantation during thyroidectomy: a comparative study.Surgery. 1998; 124: 1081-1087
- Successful autotransplantation of the parathyroid glands during total thyroidectomy for carcinoma.Surg Gynecol Obstet. 1977; 145: 364-368
- Incidence of hypoparathyroidism after radical surgery for thyroid carcinoma and autotransplantation of parathyroid glands.Am J Surg. 1977; 134: 358-362
- Parathyroid autotransplantation during thyroid surgery.J Surg Oncol. 1991; 46: 21-24
- Parathyroid autotransplantation in total thyroidectomy.Am Surg. 1990; 56: 404-406
- Parathyroid autotransplantation in patients undergoing a total thyroidectomy: a review of 261 patients.Otolaryngol Head Neck Surg. 1994; 111: 258-264
- Morbidity of thyroid surgery.Am J Surg. 1998; 176: 71-75
- Our technique of parathyroid autotransplantation in operation for papillary thyroid carcinoma.Surgery. 1993; 114: 92-96
- Parathyroid autotransplantation with total thyroidectomy for thyroid carcinoma: long-term follow-up of grafted parathyroid function.Surgery. 1999; 125: 504-508
- Heterotopic autotransplantation of parathyroid tissue in children undergoing total thyroidectomy.J Ped Surg. 1997; 32: 510-513
- Total thyroidectomy and parathyroid autotransplantation for radiation associated thyroid cancer.Surgery. 1976; 80: 70-76
- Routine autotransplantation of at least one parathyroid gland during total thyroidectomy may reduce permanent hypoparathyroidism to zero.Aust N Z J Surg. 1999; 69: 794-799
- Delayed hypocalcemia after thyroidectomy for Graves' disease is prevented by parathyroid autotransplantation.Ann Surg. 1979; 190: 508-513
- Parathyroid autotransplantation during thyroidectomy: Is frozen section necessary?.Arch Surg. 1999; 134: 258-260
- Prospective biochemical and scintigraphic evaluation of autografted normal parathyroid glands in patients undergoing thyroid operations.Surgery. 1998; 124: 1005-1010
- Risk factors for postthyroidectomy hypocalcemia.Surgery. 1994; 116: 641-648
- In situ preservation of the parathyroid glands during operations on the thyroid.Eur J Surg. 1997; 163: 33-37
- Human parathyroid blood supply determined by laser-Doppler flowmetry.World J Surg. 1994; 18: 417-420
- Parathyroid biopsy to facilitate the preservation of functional parathyroid tissue during thyroidectomy.Head Neck. 1999; 21: 442-446
- Hypocalcemia following thyroid surgery: incidence and prediction of outcome.World J Surg. 1998; 22: 714-718
- Intraoperative monitoring of parathyroid procedures by a 15-minute parathyroid hormone immunochemiluminometric assay.Mayo Clin Proc. 1994; 69: 532-537
Article info
Publication history
Accepted:
August 26,
2000
Footnotes
☆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.
Identification
Copyright
© 2001 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
