Forearm parathyroid reimplantation may be effective in preventing hypoparathyroidism

1. Ninety-six percent of patients recovered their parathyroid function by 3 months following forearm parathyroid reimplantation surgery.

2. One patient did not recover parathyroid function, which was attributed to a hematoma that developed postoperatively.

Evidence Rating Level: 2 (Good)

Study Rundown: Parathyroid reimplantation provides an effective means of preventing hypoparathyroidism in cases of devascularized or accidentally removed parathyroid glands during thyroid surgery. Over the last several decades, various reimplantation techniques have been described with the preferred site being the intramuscular pocket of the sternocleidomastoid muscle. However, this approach has a major disadvantage of limiting surgeons from checking function and vitality of reimplanted parathyroid glands postoperatively. In this study, researchers evaluated the role of forearm parathyroid reimplantation during thyroidectomy as this technique would afford a simpler and less invasive method of reimplantation and permit a postoperative evaluation of graft function and vitality. Almost all patients in the study population demonstrated normal overall parathyroid gland function by 3 months following reimplantation surgery, highlighting the potential benefit of this technique in future thyroid surgeries. An important strength of this study is its prospective study design and broad patient selection criteria providing high external validity. However, its limitations include a small sample size and a short duration of follow-up.

Click to read the study in The World Journal of Surgery

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

In-Depth [prospective study]: Twenty-five patients out of 348 consecutive thyroidectomies performed at a single institution from January 2013 to August 2014 were included. There was either accidental parathyroid removal or evidence of insufficient blood supply to parathyroid glands during thyroidectomy in all 25 cases.  These patients subsequently had their parathyroid glands removed, fragmented, and reimplanted into subcutaneous pockets on their non-dominant forearm. Following surgery, the authors evaluated the function and vitality of the graft by measuring serum PTH gradient difference between the reimplanted and non-reimplanted arms at 1 week, 1 month, and 3 months (a ratio of 1.5 or more was considered significant in the study). The authors found that as many as 48% and 88% of patients recovered their parathyroid function by 1 week and 1 month respectively. By 3 months, 96% (24/25) of patients gained full graft recovery. In one case that did not show graft functionality, it was presumed to be due to a postoperative development of wound hematoma at the graft-site.

Image: PD

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