Surgical strategy when identifying less than four parathyroid glands during total thyroidectomy: a retrospective cohort study

Background: Parathyroid glands protection is still controversial in patients with less than 4 parathyroid glands during thyroidectomy. The aim of this study was to investigate the strategy of parathyroid autotransplantation or in situ preservation in patients with 3 parathyroid glands. Methods: Consecutive patients who underwent primary total thyroidectomy with bilateral central neck dissection for papillary thyroid carcinoma (PTC) in our center were included retrospectively. Serum calcium and parathyroid hormone (PTH) levels (pg/mL), incidence of hypocalcemia and hypoparathyroidism during 24 months follow-up were compared grouping by the number of parathyroid glands both identified intraoperatively and confirmed postoperatively by pathology. Results: A total of 1,424 patients were included. Serum PTH and calcium levels were lower and the incidence of hypocalcemia was higher in patients with 3 identified parathyroid glands. When excluding patients with accidental parathyroid resection, the results remained similar. Of the 212 patients with 3 identified parathyroid glands, PTH levels at postoperative 12-month in patients underwent autotransplantation were significantly lower than patients with all parathyroid glands preserved in situ (3.65 +/- 1.30 vs. 4.67 +/- 1.89, P=0.026). Conclusions: The parathyroid function was weaker in patients with 3 parathyroid glands than patients with 4 before and after operation. Parathyroid glands preserved all in situ promoted better recovery of postoperative function in patients with 3 identified parathyroid glands.

Automated summary

Parathyroid protection remains controversial in patients with fewer than 4 parathyroid glands during thyroidectomy. This study found that patients with only 3 identified parathyroid glands had lower serum PTH and calcium levels postoperatively, with a higher incidence of hypocalcemia. Patients who underwent parathyroid autotransplantation had significantly lower PTH levels compared to those with all parathyroid glands preserved in situ.