PARATHYROID AUTOTRANSPLANTATION DURING THYROIDECTOMY - RESULTS OF LONG-TERM FOLLOW-UP

Summ. Background Data Permanent hypoparathyroidism is a recognized com plication of thyroidectomy. Operative strategies to prevent this compl ication include preservation of parathyroid glands in situ and autotra nsplantation of parathyroid glands resected or devascularized during t hyroidectomy. Methods An analysis of 194 patients having thyroidectomy and simultaneous parathyroid autotransplantation at Barnes Hospital f rom 1990 to 1994 was performed. Data were collected regarding patient demographics, indication for thyroidectomy, operative procedure, patho logic diagnoses, and postoperative course, including biochemical asses sment of parathyroid autograft function. Results Of 194 patients havin g either total, subtotal, or completion thyroidectomy, 104 (54%) exper ienced a [Ca+2](nadir) less than or equal to 8.0 mg/dL and had symptom s and signs of hypocalcemia. Parathyroid autotransplantation was succe ssful in 103 (99%) of these 104 cases and resulted in a 1.0% incidence of hypoparathyroidism in this series. Conclusions Although preservati on of parathyroid glands in situ is desirable, routine parathyroid aut otransplantation during thyroidectomy virtually eliminates postoperati ve hypoparathyroidism. Normal parathyroid glands resected or devascula rized during thyroidectomy for well-differentiated thyroid carcinoma o r benign disease should be transplanted in the sternocleidomastoid mus cle. Patients with Multiple Endocrine Neoplasia type 2A should have pa rathyroid glands resected al the time of thyroidectomy for medullary t hyroid carcinoma and transplanted in the nondominant forearm. Postoper ative management in most patients after thyroidectomy and parathyroid autotransplantation involves temporary calcium and vitamin D replaceme nt and close biochemical evaluation. This precautionary measure of par athyroid autotransplantation markedly reduces the incidence of permane nt postoperative hypoparathyroidism.