HETEROTOPIC AUTOTRANSPLANTATION OF PARATHYROID TISSUE IN CHILDREN UNDERGOING TOTAL THYROIDECTOMY

Aim: The purpose of this study was to examine the efficacy of parathyr oid autotransplantation in children undergoing total thyroidectomy, Me thods: We have prospectively evaluated 32 cases of total thyroidectomy in children. The ages ranged from I year to 15.7 years, and the mean was 8.9 years. in 31 cases, the indication for surgery was a diagnosis of MEN2A or 2B based on direct DNA testing. One child had suspected s poradic medullary thyroid carcinoma, All of the patients underwent het erotopic autotransplantation of parathyroid gland tissue, In 26 cases, the parathyroid tissue was placed in the nondominant forearm, while i n 6 children it was autotransplanted into the sternocleidomastoid musc le. Results: In 31 of 32 children (97%), the serum calcium level trans iently decreased in the immediate postoperative period. All of the pat ients were placed on oral calcium carbonate and Vitamin D supplementat ion, and the serum calcium levels became normal within several days, T he supplemental medications were then weaned as tolerated, Within 3 mo nths of their procedure, 30 patients (94%) had adequate parathyroid ti ssue engraftment, and the calcium and vitamin D medications were disco ntinued. One child required 9 months of calcium and vitamin D medicati ons before she could be weaned from the medications. One child has bee n treated more recently, and is currently being weaned from supplement al calcium and vitamin D, Serum PTH levels in 22 patients who had plac ement of the tissue into their forearms were measured, and in each the re was increased PTH in the grafted arm compared with the nongrafted a rm. in five children who had parathyroid tissue grafted into the stern ocleidomastoid muscle, the peripheral serum PTH levels were in the nor mal range. Conclusion: The heterotopic autotransplantation of resected parathyroid tissue is safe and effective in preventing permanent hypo parathyroidism. Copyright (C) 1997 by W.B. Saunders Company.