Parathyroid autotransplantation at the time of reoperation for persistent hyperparathyroidism

During the 3-year period from 1977 through 1979, twelve patients received fresh autografts of hyperfunctioning parathyroid tissue into their forearm musculature at the time of reoperation for persistent or recurrent hyperparathyroidism. All patients were considered to be at high risk of permanent hypoparathyroidism after completion of their reoperative surgery, and parathyroid autotransplantation was undertaken in an attempt to circumvent this serious complication. Seven patients received autografts of adenomas; five were grafted with hyperplastic glands. At follow-up 4 to 35 months postoperatively, all 12 patients had functioning grafts, as evidenced either by a higher concentration (1 1/2 times or more) of immunoreactive parathyroid hormone in the antecubital venous effluent drainage the grafted arm compared with that of the nongrafted arm or by their ability to maintain a normal serum calcium level after cessation or tapering of replacement therapy. One patient with familial hyperparathyroidism who was noted to be hypercalcemic again only 2 months after removal of a 1.1 gm intrathyroid parathyroid "adenoma" at reoperation was believed to have persistent rather than recurrent hyperparathyroidism, most likely due to hyperfunction of residual hyperplastic parathyroid tissue left in situ in the neck or mediastinum.