Abstract
Background and Objectives Parathyroid failure is the most common symptom after thyroidectomy. To prevent it, a gland was preserved in situ or an ischemic one was autotransplanted. This study explored the relationship between in situ preservation of the parathyroid gland and gland failure. Methods Consecutive patients who underwent initial total thyroidectomy were enrolled retrospectively in a prospectively maintained database. Patients were divided into groups by parathyroid gland remaining in situ fraction (PGRIF) (PGRIF = number of in situ glands/(total number of identified glands − number of glands in specimen). Patients were graded by tertiles and followed at least one year after surgery. Results 559 patients were included. PGRIF is significantly inversely associated with transient hypoparathyroidism, protracted hypoparathyroidism, and postoperative hypocalcemia. PGRIF was identified as an independent risk factor for transient hypoparathyroidism, protracted hypoparathyroidism, and postoperative hypocalcemia (OR = 0.177, 0.190, and 0.330, resp.). Autotransplantation of parathyroid gland would not affect the calcium level in the long term. Conclusion In situ preservation of parathyroid gland is crucial for parathyroid function. Less preserved is the independent risk factor for postoperative hypoparathyroidism and hypocalcemia, resulting in a worse function of parathyroid gland in the long term.
Highlights
Hypoparathyroidism is a well-recognized symptom after total thyroidectomy [1,2,3]
The parathyroid gland remaining in situ fraction (PGRIF = number of in situ glands/(total number of identified glands − number of glands in specimen) was graded by tertiles (PGRIF 0–1/3, 1/3–2/3, and 2/ 3–1): IP = gland in specimen + intraoperative IP
A total of 238 patients (42.58%) developed transient hypoparathyroidism. 30 patients suffered from protracted hypoparathyroidism (5.37%), and only 3 developed permanent hypoparathyroidism (0.54%) (Figure 1)
Summary
Hypoparathyroidism is a well-recognized symptom after total thyroidectomy [1,2,3]. Parathyroid function failure is the main cause of postoperative hypoparathyroidism. We should consider the effective or functional parathyroid gland fraction when exploring the role of in situ preservation. This study explored the relationship between in situ preservation of the parathyroid gland and gland failure. PGRIF is significantly inversely associated with transient hypoparathyroidism, protracted hypoparathyroidism, and postoperative hypocalcemia. PGRIF was identified as an independent risk factor for transient hypoparathyroidism, protracted hypoparathyroidism, and postoperative hypocalcemia (OR = 0 177, 0.190, and 0.330, resp.). In situ preservation of parathyroid gland is crucial for parathyroid function. Less preserved is the independent risk factor for postoperative hypoparathyroidism and hypocalcemia, resulting in a worse function of parathyroid gland in the long term
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