Forearm Auto-Transplantation of Adenomatous Parathyroid Tissue to Prevent Post-Surgical Hypoparathyroidism: A Case Report.

Abstract

Background: Primary hyperparathyroidism (PHPT) is commonly treated surgically, though post-surgical hypoparathyroidism (PoSH) is a significant concern. Most studies focus on the auto-transplantation of healthy parathyroid glands, especially in multi-gland disease cases such as multiple endocrine neoplasia type 1 (MEN1) syndrome. However, limited data exist on auto-transplantation of pathological glands in single-gland disease due to concerns over recurrence.

Objectives: This case report describes the successful management of persistent PHPT using the auto-transplantation of adenomatous parathyroid tissue, preventing long-term hypoparathyroidism.

Methods: A male patient in his 40s presented with persistent PHPT after previous surgery and inadvertent excision of three normal parathyroid glands. Re-operative exploration with excision of the last remaining parathyroid gland was performed, and the excised tissue was transplanted into the forearm.

Results: Six months post-surgery, the patient was weaned off active vitamin treatments as hypoparathyroidism resolved. Five years after surgery, calcium and parathyroid hormone (PTH) levels remained normal, with no recurrence of hypercalcaemia.

Conclusions: This case illustrates that forearm auto-transplantation of pathological parathyroid tissue can restore parathyroid function, prevent long-term hypoparathyroidism and avoid recurrence over a five year period.