Routine parathyroid autotransplantation during total thyroidectomy: the influence of technique.

OBJECTIVE

To find out whether injecting a suspension of finely minced parathyroid tissue into the muscle bed had any adverse outcomes as it is simpler and potentially safer than implanting parathyroid tissue into muscle pockets.

DESIGN

Prospective, randomised, controlled clinical trial.

SETTING

University hospital, Australia.

PATIENTS

50 patients who were to have total thyroidectomy and routine parathyroid autotransplantation.

INTERVENTIONS

Patients were randomised to either the injection technique or the implantation technique.

MAIN OUTCOME MEASURES

Clinical assessment; corrected serum calcium and intact parathyroid hormone concentrations (PTH) measured immediately before, and at 1 day, 2 weeks, and 3 months after operation.

RESULTS

Calcium was reduced significantly in both groups immediately after thyroidectomy. Although mean PTH concentrations decreased immediately after thyroidectomy and parathyroid autotransplantation in both groups, these changes were significant only in the implantation group. By 2 weeks and again by 3 months, calcium and intact parathyroid hormone concentrations had returned to baseline in both groups. At 3 months, 2 patients in each group still required some form of calcium supplement. At 6 months, no patients in the injection group required supplement.

CONCLUSIONS

Injection of a suspension of parathyroid tissue is a simple, safe, and rapid technique for parathyroid autotransplantation during total thyroidectomy and is not associated with any more adverse outcome than is the standard technique.