Does Parathyroid Autotransplantation Prevent Hypoparathyroidism after Thyroid Surgery?

Objective: To assess the impact of parathyroid gland autotransplantation on the restoration of parathyroid function in patients who are hypoparathyroid after thyroidectomy.

Background data: Hypoparathyroidism post-thyroidectomy arises when all parathyroid glands are devascularized or injured. Autotransplantation of compromised parathyroids aims to preserve their function and prevent permanent hypoparathyroidism. Despite routine use, comprehensive evidence on the efficacy of parathyroid autotransplantation remains limited.

Methods: A retrospective analysis was conducted on 549 patients who underwent total or completion thyroidectomy from December 2015 to June 2023. Surgical outcomes of patients with and without parathyroid autotransplantation were compared. A subgroup analysis included patients with post-anesthesia care unit (PACU) parathyroid hormone (PTH) levels below 10 units. Statistical analyses included the Chi-squared test and multivariable analysis.

Results: Of the 549 patients, 152 (27.7%) had parathyroid autotransplantation and 397 (72.3%) did not. The groups were similar in demographics and underlying thyroid etiologies. No significant difference was found in intraoperative parathyroid identification rates (P=0.25). Postoperatively, autotransplanted patients had a higher incidence of transient symptomatic hypocalcemia at 2 weeks (38.0% vs. 19.3%, P<0.001). Multivariable regression showed a higher frequency of postoperative transient hypocalcemia with autotransplantation (IRR=1.90, 95% CI: 1.42-2.54, P<0.001). Among patients with PACU PTH<10 units, recovery rates of parathyroid function were similar between treatment groups (82.2% vs. 82.5%, P=0.46). Long-term follow-up showed comparable low incidence of parathyroid insufficiency in both groups (5.3% vs. 3.8%, P=0.46).

Conclusions: Parathyroid autotransplantation does not enhance recovery in hypoparathyroid patient's post-thyroidectomy and does not significantly alter outcomes among patients with PACU PTH<10 .