Postoperative hypocalcemia in patients who did or did not undergo parathyroid autotransplantation during thyroidectomy: A comparative study

Background. Permanent hypoparathyroidism is a recognized complication of thyroidectomy. Apart from preservation of parathyroid glands in situ by meticulous dissection, parathyroid autotransplantation (PTHAT) has been performed increasingly to avoid permanent hypoparathyroidism. Methods. From January 1995 to October 1997, PTHAT was performed routinely for devascularized or inadvertently removed glands in 98 (36%) of 271 patients undergoing thyroidectomy. Potential risk factors and the impact of PTHAT on postoperative hypocalcemia were studied. Results, Postoperative hypocalcemia occurred in 40 patients (14.8 %), whereas 5 patients (1.8 %) had permanent hypocalcemia during a median follow-up of 9 months. The incidence of transient hypocalcemia (n = 35) was higher in patients who underwent PTHAT (21.4 qb) than in patients who did not undergo PTHAT (8.1 %) (P <.01). Permanent hypocalcemia occurred only in patients who did not undergo PTHAT None of the 21 patients who had postoperative hypocalcemia after PTHAT had permanent hypoparathyroidism compared with 26% (5/19) of patients who did not undergo PTHAT (P = .018). When the resected thyroid gland was examined for parathyroid tissue, the incidence of positive identification was higher in patients who did not undergo PTHAT (13 %) than in patients who did undergo PTHAT (4 %) (P = .015). Conclusions, Patients with postoperative hypocalcemia after PTHAT have virtually no risk of having permanent hypoparathyroidism. A more careful examination of the resected thyroid tissue can help to identify inadvertently removed parathyroid glands for autotransplantation.