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Routine parathyroid autotransplantation during total thyroidectomy: the influence of technique
P G Gauger1, T S Reeve, M Wilkinson
1Endocrine Surgical Unit, Department of Surgery, Royal North Shore Hospital, University of Sydney, NSW, Australia.
Objective:
To find out whether injecting a suspension of finely minced parathyroid tissue into the muscle bed had any adverse outcomes as it is simpler and potentially safer than implanting parathyroid tissue into muscle pockets.
Design:
Prospective, randomised, controlled clinical trial.
Setting:
University hospital, Australia.
Patients:
50 patients who were to have total thyroidectomy and routine parathyroid autotransplantation.
Interventions:
Patients were randomised to either the injection technique or the implantation technique.
Main Outcome Measures:
Clinical assessment; corrected serum calcium and intact parathyroid hormone concentrations (PTH) measured immediately before, and 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 after thyroidectomy and parathyroid autotransplantation in both groups, these changes were significant only in the implantation group. By 2 weeks and again by 3 months, calcium and intact parathyroid hormone concentrations had returned to baseline in both groups. At 3 months, 2 patients in each group still required some form of calcium supplement. At 6 months, no patients in the injection group required supplement.
Conclusions:
Injection of a suspension of parathyroid tissue is a simple, safe, and rapid technique for parathyroid autotransplantation during total thyroidectomy and is not associated with any more adverse outcome than is the standard technique.