title: Parathyroid autotransplantation during thyroidectomy. Results of long-term follow-up.
abstract: BACKGROUND
  Permanent hypoparathyroidism is a recognized complication of thyroidectomy. Operative strategies to prevent this complication include preservation of parathyroid glands in situ and autotransplantation of parathyroid glands resected or devascularized during thyroidectomy.
  
  
  METHODS
  An analysis of 194 patients having thyroidectomy and simultaneous parathyroid autotransplantation at Barnes Hospital from 1990 to 1994 was performed. Data were collected regarding patient demographics, indication for thyroidectomy, operative procedure, pathologic diagnoses, and postoperative course, including biochemical assessment of parathyroid autograft function.
  
  
  RESULTS
  Of 194 patients having either total, subtotal, or completion thyroidectomy, 104 (54%) experienced a [Ca(+2)]nadir less than or equal to 8.0 mg/dL and had symptoms and signs of hypocalcemia. Parathyroid autotransplantation was successful in 103 (99%) of these 104 cases and resulted in a 1.0% incidence of hypoparathyroidism in this series.
  
  
  CONCLUSIONS
  Although preservation of parathyroid glands in situ is desirable, routine parathyroid autotransplantation during thyroidectomy virtually eliminates postoperative hypoparathyroidism. Normal parathyroid glands resected or devascularized during thyroidectomy for well-differentiated thyroid carcinoma or benign disease should be transplanted in the sternocleidomastoid muscle. Patients with Multiple Endocrine Neoplasia type 2A should have parathyroid glands resected at the time of thyroidectomy for medullary thyroid carcinoma and transplanted in the nondominant forearm. Postoperative management in most patients after thyroidectomy and parathyroid autotransplantation involves temporary calcium and vitamin D replacement and close biochemical evaluation. This precautionary measure of parathyroid autotransplantation markedly reduces the incidence of permanent postoperative hypoparathyroidism.
authors.affiliation: Department of Surgery, Washington University School of Medicine, St. Louis, MO 63111-0250, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Olson
authors.forename: M K
authors.initials: MK
authors.lastname: DeBenedetti
authors.forename: D S
authors.initials: DS
authors.lastname: Baumann
authors.forename: S A
authors.initials: SA
authors.lastname: Wells
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007011:Hypoparathyroidism / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000637:transplantation*; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D013965:Thyroidectomy / Q000379:methods / Q000706:statistics & numerical data; D013997:Time Factors; D014182:Transplantation, Autologous