title: Failure of fragmented parathyroid gland autotransplantation to prevent permanent hypoparathyroidism after total thyroidectomy.
abstract: OBJECTIVE
  Parathyroid autotransplantation during total thyroidectomy leads to higher rates of postoperative hypocalcaemia. It has been argued, however, that it prevents permanent hypoparathyroidism. The impact of autografted normal parathyroid gland fragments on long-term parathyroid status has not been assessed properly. To clarify this, the short- and long-term parathyroid function was assessed in patients with three glands remaining in situ after total thyroidectomy, in whom the fourth gland was either autotransplanted (Tx) or accidentally resected (AR).
  
  
  METHODS
  Consecutive patients (n = 669) undergoing first-time total thyroidectomy were prospectively studied recording the number of parathyroid glands remaining in situ: PGRIS =4-(glands autografted + glands in the specimen). The study was focused on the subgroup of 186 patients with three parathyroid glands remaining in situ as a result of either accidental resection (AR, n = 76) or autotransplantation into the sternocleidomastoid muscle (Tx, n = 110). Prevalence of postoperative hypocalcaemia, protracted, and permanent hypoparathyroidism were compared between the two groups. Demographic, disease-related, laboratory, and surgical variables were recorded. All patients were followed for at least 1 year.
  
  
  RESULTS
  Both groups were comparable in terms of disease and extent of surgery. Mean postoperative serum calcium was the same (AR: 1.97 ± 0.2 vs Tx: 1.97 ± 0.22 mmol/L). Rates of protracted (AR: 24% vs Tx: 25.5%) and permanent hypoparathyroidism (AR: 5.3% vs Tx: 7.3%) were similar in both groups.
  
  
  CONCLUSIONS
  The prevalence of parathyroid failure syndromes after total thyroidectomy was similar whether a parathyroid gland was inadvertently excised or autotransplanted. Autotransplantation did not influence the permanent hypoparathyroidism rate.
authors.affiliation: Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: Leyre
authors.initials: L
authors.lastname: Lorente-Poch
authors.affiliation: Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Sancho
authors.affiliation: Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Muñoz
authors.affiliation: Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: Lander
authors.initials: L
authors.lastname: Gallego-Otaegui
authors.affiliation: Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Martínez-Ruiz
authors.affiliation: Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain. asitges@hospitaldelmar.cat.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sitges-Serra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000453:epidemiology / Q000517:prevention & control*; D007011:Hypoparathyroidism / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000637:transplantation*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D013959:Thyroid Diseases / Q000097:blood / Q000150:complications / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects*; D014182:Transplantation, Autologous; D017211:Treatment Failure; D055815:Young Adult
keywords: Parathyroid autotransplantation; Permanent hypoparathyroidism; Postoperative hypocalcaemia; Total thyroidectomy