ArticleBJS open2026
Parathyroid autotransplantation for inadvertently resected or devascularized glands during total thyroidectomy: large retrospective cohort study.
Article in BJS open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAlthough recent guidelines recommend parathyroid autotransplantation for inadvertent excision of ischaemic glands, its benefit for the recovery of parathyroid function after total thyroidectomy remains uncertain.
methodsThis retrospective study analysed patients with normal parathyroid hormone (PTH) concentrations who underwent primary total thyroidectomy at Sun Yat-sen University Cancer Center between September 2013 and November 2024. Postoperative hypoparathyroidism and PTH trajectories were compared across three groups: autotransplantation, inadvertent parathyroid resection, and all glands preserved in situ. Long-term recovery was modelled using generalized additive mixed models (GAMM).
resultsOf 7539 eligible patients, 441 (5.8%) underwent autotransplantation and 814 (10.8%) had inadvertent parathyroid resection. Higher proportions of parathyroid autotransplantation or inadvertent resection were observed among patients undergoing central neck dissection, particularly bilateral procedures. Postoperative (POD) 1 hypoparathyroidism (PTH < 15 pg/ml) occurred in 64.9% and 62.4% of patients in the autotransplantation and inadvertent resection groups, respectively, compared with 50.7% of patients with in situ gland preservation. At 1 month, hypoparathyroidism was present in 17.1% and 22.5% of patients in the autotransplantation and inadvertent resection groups, respectively, compared with 11.9% of patients with in situ gland preservation. Among patients with POD1 hypoparathyroidism, the recovery of parathyroid function at 1 month was similar in the autotransplantation and in situ preservation groups (∼72% and ∼74%, respectively), but lower in the group with inadvertent resection (∼62%). GAMMs showed poorest long-term recovery after inadvertent resection, whereas recovery in the autotransplantation group approached in situ preservation without clear superiority.
conclusionsParathyroid autotransplantation improved long-term recovery compared with inadvertent resection but did not outperform in situ preservation. These findings support autotransplantation for inadvertently resected parathyroid glands, but not for devascularized glands.
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