J. Y. Liu1, C. J. Weber1, J. Sharma1 1Emory University School Of Medicine,General Surgery,Atlanta, GA, USA
Introduction: A recognized complication of thyroidectomy is the development of permanent hypoparathyroidism (PH). In an effort to prevent this complication, parathyroid glands can be autografted during thyroidectomy. Our aim was to identify factors that increased the likelihood of a parathyroid autograft (PA) during thyroidectomies.
Methods: A database of patients undergoing thyroidectomy between 2008-2014 was queried. Frequency of PA, lobe and location of parathyroid, preoperative diagnosis, and type of procedure performed were analyzed. PA was performed when the parathyroid was inviable or in the specimen, and by finely mincing parathyroids and then injecting with a 14 gauge angiocatheter into the sternocleidomastoid muscle.
Results: 856 patients were analyzed with an autograft rate of 33.5% (n=286). PA occurred more frequently of the inferior parathyroids at 53.7% (n=153) compared to 27% (n=77) of the superior parathyroids and 19.3% (n=55) of both. All parathyroids were identified in 32.5% of cases (n=277). A single parathyroid was autografted in 211 cases, two in 66 and three in 9. On multivariate analysis, total thyroidectomy (TTX) (OR 16.5, p=<0.001), partial thyroidectomy (OR 4.6, p=0.047), and the identification of all parathyroids (OR 4.7, p=<0.001) were associated with increased use of PA. However, gland size, preoperative diagnosis and lymph node dissection did not increase the use of PA. Postoperative PTH was routinely measured in 138 patients undergoing TTX, and the rate of transient hypoparathyroidism was 35.5% (n=49); no patients developed PH.
Conclusion: We conclude PA is an effective adjunct to all thyroidectomies and is strongly associated with a TTX. PA can potentially prevent PH.