Recovery of parathyroid function after total thyroidectomy

To prevent postoperative hypoparathyroidism following total thyroidectomy, the parathyroid glands are preserved in situ and/or resected or devasculari zed parathyroid glands are autotransplanted. We conducted a retrospective i nvestigation utilizing biochemical and specific endocrine assessments to ev aluate the difference in recovery of parathyroid function between the two o perative methods. A total of 92 patients underwent total thyroidectomy at o ur hospital during the period between 1990 and 1997. These patients were di vided 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 restor ed by 1 gear postoperatively in 83% (69/83) of the preservation group patie nts. In the remaining 14 patients (17%), the intact PTH had fallen below de tectable levels on postoperative day (POD) 1, then subsequently recovered t o 70% of the preoperative levels. Comparatively, in the autotransplantation group, the mean level of intact PTH recovered to only 43% of the preoperat ive levels. The results of this study suggest that parathyroid glands shoul d be preserved in situ whenever possible, and that when intact PTH levels f all below detectable limits on POD 1, they may never recover to the preoper ative levels in those patients.