Permanent Hypoparathyroidism (HP) After Thyroidectomy: An Avoidable Complication

Introduction: HP is a recognized but serious complication of thyroidectomy. Conventional techniques for parathyroid autograft (PA) occur with the insertion of parathyroid slices in muscle pockets and have a published incidence... [ view full abstract ]

Introduction: HP is a recognized but serious complication of thyroidectomy. Conventional techniques for parathyroid autograft (PA) occur with the insertion of parathyroid slices in muscle pockets and have a published incidence of HP of 4-8%. The purpose of this this study was to analyze the incidence of HP after thyroidectomy at our center, where we have used a modified technique for PA.

Materials & Methods: Our PA technique was adapted from tissue culture methods.  We minced parathyroid glands very finely in saline to 1 mm fragments and reimplanted them into the ipsilateral sternocleidomastoid muscle using an angio-catheter. PA was used when a parathyroid appeared to be ischemic or to have venous congestion in situ.

Results: Between 2008 and 2014, 856 patients underwent thyroidectomy (359 totals and 447 lobectomies). PA was done during 286 operations (33.5%): (211 single glands, 66 double implants, and 9 triple glands). Inferior parathyroid glands required PA more frequently than superior glands (54% vs 26%). PA was done more frequently during total thyroidectomy than during lobectomy (OR 16.5, p=<0.001). Neither the thyroid tissue diagnosis nor the need for lymph node dissection increased the use of PA. Transient hypocalcemia (Ca++ <7.0) occurred in 14% of total thyroidectomies with PA and in 7% of total thyroidectomies without PA. No patient suffered HP after thyroid lobectomy or total thyroidectomy.

Conclusion:  Our technique for PA was effective in preserving parathyroid tissue viability and preventing HP in our thyroidectomy patients.  We recommend it to our colleagues performing thyroid surgery.