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Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy
Published on: May 12, 2023
Effectiveness of parathyroid autotransplantation during total thyroidectomy and functional recovery post-operation: A
Guannan Ge1, Ying Lu2, Hua Huang2
1Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Introduction:
Thyroid carcinoma is the most common endocrine malignancy, with total thyroidectomy being a standard treatment. However, this procedure carries a risk of hypoparathyroidism. Parathyroid autotransplantation (PAT) is recommended to prevent postoperative hypoparathyroidism, though its effectiveness and the recovery of parathyroid function remain poorly understood.
Methods:
A retrospective study was conducted on patients who underwent total thyroidectomy with four-gland PAT at Peking Union Medical College Hospital between April 2012 and February 2024. Exclusion criteria included postoperative serum calcium levels >2.11 mmol/L without supplementation within 48 h and inadequate follow-up. Preoperative and postoperative serum calcium and parathyroid hormone (PTH) levels were analysed at multiple time points to assess parathyroid function recovery and the effectiveness of PAT. Patients were divided into an immediate transplantation group and a non-immediate transplantation group based on the timing of parathyroid gland transplantation. Serum calcium levels were compared between the groups at various time points.
Results:
This study included 142 patients. Compared with preoperative levels, the mean of serum calcium and PTH levels significantly decreased at 24 h, 48 h and 1week postoperatively. From 1 month post-surgery serum calcium and PTH levels showed no significant difference compared with preoperative levels. The immediate transplantation group had higher serum calcium levels within the first month compared to the non-immediate group, but no significant difference was observed at later time points. Permanent hypoparathyroidism occurred in 1.4 % (2/142) of patients.
Conclusion:
PAT is effectively restores and maintains parathyroid function following total thyroidectomy. Functional recovery begins 1 week post-PAT and is complete in 1 month with stable function thereafter. Minimising in vitro parathyroid gland manipulation and performing PAT immediately can enhance early recovery of parathyroid function.
