# Selective parathyroid autotransplantation prevent permanent hypoparathyroidism after total thyroidectomy with central neck dissection

## TL;DR

This study shows that selectively autotransplanting parathyroid glands during thyroid surgery reduces the risk of permanent hypoparathyroidism.

## Contribution

The study demonstrates that selective parathyroid autotransplantation independently prevents permanent hypoparathyroidism after thyroidectomy.

## Key findings

- Patients who received autotransplanted glands had significantly lower rates of permanent hypoparathyroidism (1.2% vs. 4.4%).
- Increasing the number of autotransplanted glands further reduced the risk of permanent hypoparathyroidism.
- Multivariate analysis confirmed that autotransplantation independently prevents the condition.

## Abstract

The impact of parathyroid gland autotransplantation on permanent hypoparathyroidism remains incompletely understood. This study aimed to ascertain how selective autotransplantation of parathyroid glands affects the occurrence of permanent hypoparathyroidism after total thyroidectomy with central neck dissection (CND).

A retrospective cohort study encompassed consecutive patients with papillary thyroid carcinoma who underwent primary total thyroidectomy plus CND from January 2008 to December 2010 and January 2012 to December 2019. Patients were categorized into two groups (0 and ≥1 parathyroid glands autotransplanted, respectively).

The autotransplantation group comprised 501 patients, while the non-autotransplantation group comprised 652 patients. The autotransplantation group showed significantly lower permanent hypoparathyroidism than the non-autotransplantation group [1.2% (6 of 501) vs. 4.4% (29 of 652), P = 0.001]. Out of the total 1,153 patients, 652 (56.5%) had no autotransplanted glands, and 358 (31.0%), 136 (11.8%), and 7 (0.6%) had 1, 2, and 3 glands autotransplanted, respectively. As the number of autotransplanted glands increased (from 0 to 3), the prevalence of permanent hypoparathyroidism was 4.4% (29 of 652), 1.4% (5 of 358), 0.7% (1 of 136), and 0.0% (0 of 7), respectively (P = 0.016). Multivariate logistic analysis revealed that parathyroid autotransplantation independently prevented postoperative permanent hypoparathyroidism.

Selective parathyroid autotransplantation is associated with a lower risk of permanent postoperative hypoparathyroidism. Autotransplantation is recommended for parathyroid glands that are devascularized or challenging to preserve in their original location.