Routine parathyroid autotransplantation during total thyroidectomy: the influence of technique

Ojective: To find out whether injecting a suspension of finely minced parat hyroid tissue into the muscle bed had any adverse outcomes as it is simpler and potentially safer than implanting parathyroid tissue into muscle pocke ts. Design: Prospective, randomised, controlled clinical trial. Setting: University hospital, Australia. Patients: 50 patients who were to have total thyroidectomy and routine para thyroid autotransplantation. Interventions: Patients were randomised to either the injection technique o r the implantation technique. Main outcome measures: Clinical assessment; corrected serum calcium and int act parathyroid hormone concentrations (PTH) measured immediately before, a nd at 1 day, 2 weeks, and 3 months after operation. Results: Calcium was reduced significantly in both groups immediately after thyroidectomy. Although mean PTH concentrations decreased immediately afte r thyroidectomy and parathyroid autotransplantation in both groups, these c hanges were significant only in the implantation group. By 2 weeks and agai n by 3 months, calcium and intact parathyroid hormone concentrations had re turned to baseline in both groups. At 3 months, 2 patients in each group st ill required some form of calcium supplement. At 6 months, no patients in t he injection group required supplement. Conclusions: Injection of a suspension of parathyroid tissue is a simple, s afe, and rapid technique for parathyroid autotransplantation during total t hyroidectomy and is not associated with any more adverse outcome than is th e standard technique.