Parathyroid Autotransplantation in Patients Undergoing a Total Thyroidectomy: A Review of 261 Patients

1994 ◽  
Vol 111 (3P1) ◽  
pp. 258-264 ◽  
Author(s):  
Regina P. Walker ◽  
Edward Paloyan ◽  
Timothy F. Kelley ◽  
Chellam Gopalsami ◽  
Harriet Jarosz
Keyword(s):  
Vitamin D ◽  
Total Thyroidectomy ◽  
Blood Supply ◽  
Frozen Section ◽  
Parathyroid Tissue ◽  
Vitamin D Supplementation ◽  
Parathyroid Glands ◽  
Parathyroid Autotransplantation ◽  
Parathyroid Function

Parathyroid autotransplantation was first described in 1907 by Halsted. However, this simple and effective method of preserving parathyroid function has been used with increasing frequency only during the past 25 years. Beginning in the late 1960s, our group has transplanted normal parathyroid tissue into the ipsilateral sternocleidomastoid muscle whenever these glands could not be preserved in situ with adequate blood supply. In addition, if the blood supply of all four parathyroid glands appeared compromised, cryopreservation of parathyroid tissue was performed in case the autotransplanted tissue did not function after surgery. Since 1970, 393 patients underwent a total thyroidectomy. Parathyroid glands that could not be saved in situ were biopsied to confirm their identity by frozen section and then autotransplanted. Of the 393 patients who underwent a total thyroidectomy, 261 patients required transplantation of one or more glands. Among those 261 patients who underwent selective parathyroid autotransplantation, 33 (13%) required temporary calcium and vitamin D supplementation. Of these 33 patients, 2 (less than 1%) had permanent hypoparathyroidism and are receiving long-term vitamin D therapy.

Late Recovery of Parathyroid Function after Total Thyroidectomy in Children and Adults: Is There a Difference?

2021 ◽  
pp. 1-9
Author(s):  
Mechteld C. de Jong ◽  
Leyre Lorente-Poch ◽  
Joan Sancho-Insenser ◽  
Virginia Rozalén García ◽  
Caroline Brain ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Young Patients ◽  
Vitamin D Supplementation ◽  
Parathyroid Function ◽  
Centre Database ◽  
Extent Of Surgery ◽  
Late Recovery

Background: Parathyroid failure after total thyroidectomy is the commonest adverse event amongst both children and adults. The phenomenon of late recovery of parathyroid function, especially in young patients with persistent hypoparathyroidism, is not well understood. This study investigated differences in rates of parathyroid recovery in children and adults and factors influencing this. Methods: A joint dual-centre database of patients who underwent a total thyroidectomy between 1998 and 2018 was searched for patients with persistent hypoparathyroidism, defined as dependence on oral calcium and vitamin D supplementation at 6 months. Demographic, surgical, pathological, and biochemical data were collected and analysed. <F00_Regular>Parathyroid Glands Remaining</F00_Regular> in Situ (PGRIS) score was calculated. Results: Out of 960 patients who had total thyroidectomy, 94 (9.8%) had persistent hypoparathyroidism at 6 months, 23 (24.5%) children with a median [range] age 10 [0–17], and 71 (75.5%) adults aged 55 [25–82] years, respectively. Both groups were comparable regarding sex, indication, extent of surgery, and PGRIS score. After a median follow-up of 20 months, the parathyroid recovery rate was identical for children and adults (11 [47.8%] vs. 34 [47.9%]; p = 0.92). Sex, extent, and indication for surgery had no effect on recovery (all p > 0.05). PGRIS score = 4 (HR = 0.48) and serum calcium >2.25 mmol/L (HR = 0.24) at 1 month were associated with a decreased risk of persistent hypoparathyroidism on multivariate analysis (p < 0.05). Conclusion: Almost half of patients recovered from persistent hypoparathyroidism after 6 months; therefore, the term persistent instead of permanent hypoparathyroidism should be used. Recovery rates of parathyroid function in children and adults were similar. Regardless of age, predictive factors for recovery were PGRIS score = 4 and a serum calcium >2.25 mmol/L at 1 month.

scholarly journals Time to parathyroid function recovery in patients with protracted hypoparathyroidism after total thyroidectomy

2018 ◽  
Vol 178 (1) ◽  
pp. 103-111 ◽  
Author(s):  
Inés Villarroya-Marquina ◽  
Juan Sancho ◽  
Leyre Lorente-Poch ◽  
Lander Gallego-Otaegui ◽  
Antonio Sitges-Serra
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Calcium Concentration ◽  
Common Adverse Effect ◽  
Parathyroid Glands ◽  
Permanent Hypoparathyroidism ◽  
Serum Calcium Concentration ◽  
Parathyroid Function

Objective Hypocalcaemia is the most common adverse effect after total thyroidectomy. It recovers in about two-thirds of the patients within the first postoperative month. Little is known, however, about recovery of the parathyroid function (RPF) after this time period. The aim of the present study was to investigate the time to RPF in patients with protracted (>1 month) hypoparathyroidism after total thyroidectomy. Design Cohort prospective observational study. Methods Adult patients undergoing total thyroidectomy for goitre or thyroid cancer. Cases with protracted hypoparathyroidism were studied for RPF during the following months. Time to RPF and variables associated with RPF or permanent hypoparathyroidism were recorded. Results Out of 854 patients undergoing total thyroidectomy, 142 developed protracted hypoparathyroidism. Of these, 36 (4.2% of the entire cohort) developed permanent hypoparathyroidism and 106 recovered: 73 before 6 months, 21 within 6–12 months and 12 after 1 year follow-up. Variables significantly associated with RPF were the number of parathyroid glands remaining in situ (not autografted nor inadvertently resected) and a serum calcium concentration >2.25 mmol/L at one postoperative month. Late RPF (>6 months) was associated with surgery for thyroid cancer. RPF was still possible after one year in patients with four parathyroid glands preserved in situ and serum calcium concentration at one month >2.25 mmol/L. Conclusions Permanent hypoparathyroidism should not be diagnosed in patients requiring replacement therapy for more than six months, especially if the four parathyroid glands were preserved.

Use of pre-operative calcium and vitamin D supplementation to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy: a systematic review

2021 ◽  
pp. 1-6
Author(s):  
A S Khatiwada ◽  
A S Harris
Keyword(s):  
Systematic Review ◽  
Vitamin D ◽  
Clinical Trials ◽  
Total Thyroidectomy ◽  
Risk Reduction ◽  
Operative Treatment ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Vitamin D Supplementation ◽  
Absolute Reduction

Abstract Objective This systematic review aimed to establish the evidence behind the use of pre-operative calcium, vitamin D or both calcium and vitamin D to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy. Method This review included prospective clinical trials on adult human patients that were published in English and which studied the effects of pre-operative supplementation with calcium, vitamin D or both calcium and vitamin D on the rate of post-operative hypocalcaemia following total thyroidectomy. Results Seven out of the nine trials included reported statistically significantly reduced rates of post-operative laboratory hypocalcaemia (absolute risk reduction, 13–59 per cent) and symptomatic hypocalcaemia (absolute reduction, 11–40 per cent) following pre-operative supplementation. Conclusion Pre-operative treatment with calcium, vitamin D or both calcium and vitamin D reduces the risk of post-operative hypocalcaemia and should be considered in patients undergoing total thyroidectomy.

Oral calcium and vitamin D supplementation after total thyroidectomy: Does it worth?

2014 ◽  
Vol 11 (3) ◽  
pp. 98 ◽  
Author(s):  
Mohamed El-Shinawi ◽  
Mohamed Nada ◽  
Tarek Youssef ◽  
Essam Fakhry ◽  
Salah Raslan ◽  
...  
Keyword(s):  
Vitamin D ◽  
Total Thyroidectomy ◽  
Vitamin D Supplementation ◽  
Oral Calcium

Management of Completion and Total Thyroidectomy Patients Based on 1-Hour Postoperative Parathyroid Hormone

2016 ◽  
Vol 82 (10) ◽  
pp. 881-884
Author(s):  
Joshua Park ◽  
Ethan Frank ◽  
Alfred Simental ◽  
Sara Yang ◽  
Christopher Vuong ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Early Discharge ◽  
Vitamin D Supplementation ◽  
Initial Management ◽  
Management Protocol ◽  
Symptomatic Hypocalcemia ◽  
Risk Patients ◽  
One Year

After thyroid surgery, protocols based on postoperative parathyroid hormone (PTH) levels may prevent symptoms of hypocalcemia, while avoiding unnecessary prophylactic calcium and/or vitamin D supplementation. We examined the value of an initial management protocol based solely on a single PTH level measured one hour after completion or total thyroidectomy to prevent symptomatic hypocalcemia by conducting a retrospective review of 697 consecutive patients treated from July 2003 to April 2015. The proportion of patients who developed symptomatic hypocalcemia was similar between those treated before (n = 155) and after (n = 542) implementation of this 1-hour PTH protocol (16.8% vs 15.9%; P = 0.786). Those in the 1-hour PTH groups had lower overnight observation rates (97.4% vs 53.7%; P < 0.001) and length of stay (1.98 ± 2.61 vs 0.89 ± 1.87 days; P < 0.001), and required less calcium (3.9% vs 0.8%; P = 0.015) and vitamin D (2.6% vs 0%; P = 0.002) supplementation one year after surgery. Less than 1 per cent of patients discharged on the day of surgery in accordance with the 1-hour PTH guidelines returned to the emergency room for symptomatic hypocalcemia; none experienced significant morbidity. This protocol facilitates early discharge of low-risk patients and results in a similar or improved postoperative course compared with traditional overnight observation.

Assessment of parathyroid autotransplantation for preservation of parathyroid function after total thyroidectomy

Head & Neck ◽  
2003 ◽  
Vol 25 (10) ◽  
pp. 799-807 ◽  
Author(s):  
Magdy I. El-Sharaky ◽  
Mohamed R. Kahalil ◽  
Ola Sharaky ◽  
Mahmoud F. Sakr ◽  
Geylan A. Fadaly ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Parathyroid Autotransplantation ◽  
Parathyroid Function

Calcium-Alkali Syndrome Associated with Hypoparathyroidism Following Total Thyroidectomy

2020 ◽  
Vol 51 (2) ◽  
pp. 160-167
Author(s):  
Sayaka Kuroya ◽  
Masahiko Yazawa ◽  
Yugo Shibagaki ◽  
Naoto Tominaga
Keyword(s):  
Vitamin D ◽  
Renal Impairment ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Metabolic Alkalosis ◽  
Calcium Supplementation ◽  
Parathyroid Autotransplantation ◽  
High Calcium

Background: Patients with permanent postsurgical hypoparathyroidism, a complication of total thyroidectomy, often require high calcium supplementation with vitamin D to maintain serum calcium levels. The epidemiology of calcium-alkali syndrome (CAS) in patients with hypoparathyroidism after total thyroidectomy remains unclear. This study aimed to investigate the incidence of hypercalcemia, renal impairment, metabolic alkalosis, and CAS in patients treated for presumed hypoparathyroidism after total thyroidectomy. Methods: Twenty-seven patients with neck cancers who underwent total thyroidectomy without parathyroid autotransplantation between January 2010 and October 2013 at our hospital were consecutively included. All patients received calcium lactate and alfacalcidol for postsurgical hypocalcemia. We defined hypercalcemia as a corrected serum calcium level (cCa) ≥10.5 mg/dL, metabolic alkalosis as a difference in serum sodium and serum chloride ([sNa-sCl]) ≥39 mEq/L, and renal impairment as a ≥50% increase in serum creatine and/or ≥35% decrease in estimated glomerular filtration rate (eGFR) compared to baseline. Results: cCa peaked (11.1 ± 1.5 mg/dL) at a median of 326 days (interquartile range 78–869) after surgery. At peak cCa, [sNa-sCl] was significantly higher (p < 0.01), and eGFR was significantly lower (p < 0.01) than that at baseline. Fifteen patients (55.6%) had hypercalcemia, 19 (70.3%) had alkalosis, 12 (44.4%) had renal impairment, and 9 (33.3%) had CAS. Patients with CAS (mean age 67.1 ± 10.8 years) were older than those without CAS (56.7 ± 13.6 years, p = 0.06). The mean dose of alfacalcidol in the CAS group (3.1 ± 1.2 μg/day) was significantly larger than that in the non-CAS group (2.1 ± 1.0 μg/day, p = 0.03). Conclusions: This retrospective study reveals the high incidence of CAS in patients with hypoparathyroidism after total thyroidectomy. Furthermore, these findings suggest that the serum calcium level, acid-base balance, and renal function should be closely monitored in patients with postsurgical hypoparathyroidism who receive large doses of active vitamin D.

Is therapy with calcium and vitamin D and parathyroid autotransplantation useful in total thyroidectomy for preventing hypocalcemia?

Head & Neck ◽  
2008 ◽  
Vol 30 (9) ◽  
pp. 1148-1154 ◽  
Author(s):  
Bassam Abboud ◽  
Ghassan Sleilaty ◽  
Salam Zeineddine ◽  
Carla Braidy ◽  
Rony Aouad ◽  
...  
Keyword(s):  
Vitamin D ◽  
Total Thyroidectomy ◽  
Parathyroid Autotransplantation

The calcimimetic R-568 increases vitamin D receptor expression in rat parathyroid glands

2007 ◽  
Vol 292 (5) ◽  
pp. F1390-F1395 ◽  
Author(s):  
M. E. Rodriguez ◽  
Y. Almaden ◽  
S. Cañadillas ◽  
A. Canalejo ◽  
E. Siendones ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Receptor ◽  
Parathyroid Tissue ◽  
Receptor Expression ◽  
Parathyroid Glands ◽  
In Vivo Studies ◽  
Control Treatment ◽  
Maximum Increase

We previously demonstrated that extracellular calcium regulates vitamin D receptor (VDR) expression by parathyroid cells. Since the calcimimetic R-568 potentiates the effects of calcium on the calcium-sensing receptor, it was hypothesized that administration of R-568 may result in increased VDR expression in parathyroid tissue. In vitro studies of the effect of R-568 on VDR mRNA and protein were conducted in cultures of whole rat parathyroid glands and human hyperplastic parathyroid glands. In vivo studies in Wistar rats examined the effect of R-568 and calcitriol alone and in combination. Incubation of rat parathyroid glands in vitro with R-568 (0.001–1 μM) resulted in a dose-dependent decrease in parathyroid hormone (PTH) secretion and an increase in VDR expression (mean ± SE). Incubation in 1 mM calcium + 0.001 μM R-568 elicited an increase in VDR mRNA (306 ± 46%) similar to the maximum increase detected with 1.5 mM calcium (330 ± 42%). In vivo, VDR mRNA was increased after administration of R-568 (168 ± 9%, P < 0.001 vs. control) or calcitriol (198 ± 16%, P < 0.001 vs. control). Treatment with R-568 also increased VDR protein in normal rat parathyroid glands and in human parathyroid glands with diffuse, but not nodular, hyperplasia. In conclusion, the present study shows that the calcimimetic R-568 exerts a stimulatory effect on VDR expression in the parathyroid glands of study models and provides additional evidence for the use of calcimimetics in the treatment of secondary hyperparathyroidism.

scholarly journals Measurement of serum intact parathyroid hormone (iPTH) at the end of total thyroidectomy: A reliable parameter for hypocalcemia?

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
A Lalos ◽  
K Linke ◽  
M von Flüe ◽  
B Kern
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Clinical Symptoms ◽  
Parathyroid Tissue ◽  
Postoperative Management ◽  
Parathyroid Glands ◽  
Intact Parathyroid Hormone ◽  
Postoperative Hypoparathyroidism ◽  
Symptomatic Hypocalcemia ◽  
The Mean

Abstract Objective Total thyroidectomy represents the gold standard surgical procedure for patients with malignant thyroid disease. Over the past decades, the total thyroidectomy gradually replaced the subtotal thyroidectomy for benign thyroid disorders as well. Postoperative hypocalcemia remains the most frequent complication. The close proximity of parathyroid glands to the thyroid capsule leads often to devascularization or adventitious removal of parathyroid tissue. Clinical symptoms like paresthesia, tingling, muscle cramps or seizures often occur. Combined measurement of intact parathyroid hormone (iPTH) and calcium after the operation are used worldwide to predict postoperative hypoparathyroidism. The purpose of this study was to find out the incidence of decreased iPTH at the end of surgery and its reliability in predicting hypocalcemia. Methods We performed a retrospective analysis of 534 patients who underwent total thyroidectomy at our institution between 2000 and 2019. Medical records were reviewed to analyze the patient characteristics, indication of the procedure, laboratory and histological results, postoperative management and complications. The iPTH was measured before and at the end of the surgery, while the calcium was measured at the first postoperative day. The iPTH assay at our hospital has a normal range between 15.0 and 80.0 pg/ml. Meanwhile hypocalcemia was defined as a calcium measurement &lt; 2.2 mmol/l. Results The mean age of the patients was 55.34 years. The female to male ratio was 4.6:1. The mean preoperative iPTH of our cohort was 48.35 pg/ml, while the postoperative iPTH was 31.74 pg/ml, indicating a mean reduction of 35.75%. A total of 174 patients (32.6%) had a iPTH &lt; 15.0 pg/ml at the end of the surgery, indicating a reduction of 75.6%. 22 of these 174 patients (12.6%) developed clinical symptoms of hypocalcemia. In contrast only 3 patients (0.08%) with normal iPTH developed symptoms. Whole parathyroid glands were identified in 95/534 (17.8%), whereas from the 174 patients with iPTH &lt; 15.0 pg/ml, 56 (32.2%) had at least one parathyroid gland in the operative specimens. Conclusion Measurement of iPTH at the end of total thyroidectomy is a good predictor to detect patient who are at risk for developing symptomatic hypocalcemia and calcium substitution can be started at the same day. A normal iPTH almost excludes symptomatic hypocalcemia.

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