Intra- and postoperative parathyroid hormone-kinetics do not advocate for autotransplantation of discolored parathyroid glands during thyroidectomy.
BACKGROUND
Thyroidectomy continues to pose the risk of typical complications, including postoperative hypocalcemia and permanent hypoparathyroidism. The strategic decision on how to preserve parathyroid hormone (PTH) secretion relies on assessing the viability of the parathyroid glands (PGs). The aim of this study was to assess parathyroid discoloration as an indicator for loss of parathyroid function.


METHODS
The prospective study included 29 patients (24 women, 5 men; age 53.2 ± 13.0 years) who underwent near-total or total thyroidectomy. An intra- and postoperative PTH and calcium monitoring was performed. The intraoperative situs of the PGs was documented by a study protocol. The patients were grouped in three categories: group A, 12 patients with four visualized and normally colored PGs; group B, 13 patients with four visualized and three or four discolored PGs; group C, 4 patients who had undergone autotransplantation of two PGs.


RESULTS
Compared to group A, groups B and C showed sharper intraoperative PTH declines. PTH values recovered more quickly in group B than in group C. However, no significant differences in PTH kinetics were found in the general linear model for repeated measures (p = 0.132). However, a significantly higher incidence of protracted hypocalcemia-related symptoms for more than 14 postoperative days was found for group C (50.0%) than for groups A (0%) and B (0%; p = 0.011). None of the patients developed permanent hypoparathyroidism.


CONCLUSIONS
The function of discolored PGs is only transiently impaired and recovers within a short time after surgery. Our observations do not support autotransplantation as a generally applicable first-line intervention for discolored PGs in the absence of other criteria for autotransplantation.
Department of Surgery, Kaiserin Elisabeth Spital der Stadt Wien, Vienna, Austria.
Regina
R
Promberger
Johannes
J
Ott
Friedrich
F
Kober
Barbara
B
Mikola
Michael
M
Karik
Michael
M
Freissmuth
Michael
M
Hermann
D000328:Adult; D000368:Aged; D003116:Color; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000378:metabolism* / Q000637:transplantation; D010281:Parathyroid Hormone / Q000097:blood / Q000378:metabolism*; D011184:Postoperative Period; D011446:Prospective Studies; D012189:Retrospective Studies; D013965:Thyroidectomy / Q000009:adverse effects*; D014182:Transplantation, Autologous
D010281:Parathyroid Hormone