World Journal of Surgery

, Volume 39, Issue 8, pp 1936–1942 | Cite as

Parathyroid Reimplantation in Forearm Subcutaneous Tissue During Thyroidectomy: A Simple and Effective Way to Avoid Hypoparathyroidism

  • Giuseppe CavallaroEmail author
  • Olga Iorio
  • Marco Centanni
  • Natale Porta
  • Angelo Iossa
  • Lucilla Gargano
  • Susanna Del Duca
  • Angela Gurrado
  • Mario Testini
  • Vincenzo Petrozza
  • Gianfranco Silecchia
Original Scientific Report



Parathyroid autotransplantation plays an important role in preventing hypoparathyroidism following thyroidectomy. The preferred reimplantation site is still the sternocleidomastoid muscle, but this approach does not permit to check graft vitality postoperatively. The authors report the first prospective evaluation of normal parathyroid gland reimplantation in forearm subcutaneous tissue (using the same technique proposed during parathyroidectomy for hyperplasia) in case of devascularized or inadvertently removed glands during thyroid surgery.

Materials and methods

From January 2013 to August 2014, we performed 348 consecutive thyroidectomies for various disease, both benign and malignant. In 25 cases, due to inadvertent parathyroid removal or evidence of insufficient blood supply, we removed and fragmented the gland into 0.5–1 mm slices (one for frozen section) and reimplanted it into two subcutaneous pockets on the non-dominant forearm. After surgery we checked grafted gland function by evaluation of serum parathormone gradient between reimplanted versus non-reimplanted arm (considering significant a ratio of 1.5 or more), at 1 week, 1 and 3 months after surgery.


We observed recovery of reimplanted graft function in 48, 88 and 96 % of patients respectively at 1 week, 1 and 3 months after surgery. All patients showed normal parathormone levels in peripheral blood (non-reimplanted arm). In one case we observed post-operative wound hematoma on graft-site. This patient showed no graft functionality in post-operative period (even at 3 months follow-up).


Parathyroid gland reimplantation in forearm subcutaneous tissue during thyroid surgery is a safe, easy and effective procedure; furthermore, it allows a good control of graft functionality and would allow an easy grafted gland removal if needed.


Parathyroid Gland Hypoparathyroidism Sternocleidomastoid Muscle Parathyroid Tissue Parathyroid Hyperplasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Halsted WFP (1908) Auto and iso-transplantation in dogs of the parathyroid granules. J Exp Med 11:175–198CrossRefGoogle Scholar
  2. 2.
    Walker RP, Paloyan E, Kelley TF, Gopalsami C, Jarosz H (1994) Parathyroid autotransplantation in patients undergoing a total thyroidectomy: a review of 261 patients. Otolaryngol Head Neck Surg 111:258–264PubMedCrossRefGoogle Scholar
  3. 3.
    Wells SA, Ross AJ, Dale JK, Gray RS (1979) Transplantation of the parathyroid glands: current status. Surg Clin N Am 59:167–177PubMedGoogle Scholar
  4. 4.
    Saxe A (1993) Parathyroid autotransplantation: a review. Surgery 95:507–526Google Scholar
  5. 5.
    Prigorius S, Lorentziadis M, Stylogiannis S, Nafas R, Masouras A, Poulantzas I (1996) Experimental autotransplantation of the parathyroid gland. Br J Surg 83:410–412CrossRefGoogle Scholar
  6. 6.
    Carter WB, Uy K, Ward MD, Hoying JB (2000) Parathyroid-induced angiogenesis is VEGF dependent. Surgery 128:458–464PubMedCrossRefGoogle Scholar
  7. 7.
    Cavallaro G, Cucina A, Coluccia P, Petramala L, Polistena A, Cotesta D, Zinnamosca L, Letizia C, Rosato L, Cavallaro A, De Toma G (2010) Role of growth factors on human parathyroid adenoma cells proliferation. World J Surg 34:48–54. doi: 10.1007/s00268-009-0294-x PubMedCrossRefGoogle Scholar
  8. 8.
    Testini M, Rosato L, Avenia N, Basile F, Portincasa P, Piccinni G, Lissidini G, Biondi A, Gurrado A, Nacchiero M (2007) The impact of single parathyroid gland autotransplantation during thyroid surgery on postoperative hypoparathyroidism: a multicenter study. Transplant Proc 39:225–230PubMedCrossRefGoogle Scholar
  9. 9.
    Lo CY, Tam SC (2001) Parathyroid autotransplantation during thyroidectomy. Documentation of graft function. Arch Surg 136:1381–1385PubMedCrossRefGoogle Scholar
  10. 10.
    Moffett JM, Suliburk J (2011) Parathyroid autotransplantation. Edocr Pract 117(suppl 1):83–89CrossRefGoogle Scholar
  11. 11.
    Conzo G, Della Pietra C, Tartaglia E, Gambardella C, Mauriello C, Palazzo A, Santini L, Fei L, Rossetti G, Docimo G, Perna A (2014) Long-term function of parathyroid subcutaneous autoimplantation after presumed total thyroidectomy in the treatment of secondary hyperparathyroidism. A clinical retrospective study. Int J Surg 12(suppl 1):S165–S169PubMedCrossRefGoogle Scholar
  12. 12.
    Rawl DK, Cofer JB (2001) Parathyroid autotransplantation: an update. Endocrine 58:15–19Google Scholar
  13. 13.
    Lin DT, Patel SG, Shaha AR, Singh B, Shah JP (2002) Incidence of inadvertent parathyroid removal during thyroidectomy. Laringosope 112:608–611CrossRefGoogle Scholar
  14. 14.
    Shaha AR, Jaffe BM (1998) Parathyroid preservation during thyroid surgery. Am J Otolaryngol 19:113–117PubMedCrossRefGoogle Scholar
  15. 15.
    Sakofas GH, Stafyla V, Bramis C, Kotsifopoulos N, Kolettis T, Kassaras G (2005) Incidental parathyroidectomy during thyroid surgery: an underappreciated complication of thyroidectomy. World J Surg 29:1539–1543. doi: 10.1007/s00268-005-0032-y CrossRefGoogle Scholar
  16. 16.
    Nj Lee, Blakey JD, Calcaterra TC (1999) Unintentional parathyroidectomy during thyroidectomy. Laryngoscope 109:1238–1240CrossRefGoogle Scholar
  17. 17.
    Wingert DJ, Frisen SR, Iliopoulus JI (1986) Post-thyroidectomy hypocalcemia. Incidence and risl factors. Am J Surg 152:606–610PubMedCrossRefGoogle Scholar
  18. 18.
    Lo CY, Lam KY (1998) Postoperative hypocalcemia in patient who did or did not undergo parathyroid autotransplantation during thyroidectomy: a comparative study. Surgery 124:1081–1086PubMedCrossRefGoogle Scholar
  19. 19.
    Olson JA, De Benedetti MK, Baumann DS (1996) Parathyroid autotrasplantation during total thyroidectomy: result of long term follow-up. Ann Surg 223:472–478PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Lo CY (2002) Parathyroid autotransplantation during thyroidectomy. ANZ J Surg 72:902–907PubMedCrossRefGoogle Scholar
  21. 21.
    Zedenius J, Wadstrom C, Delbridge L (1999) Routine autotransplantation of at least one parathyroid gland during total thyroidectomy may reduce permanent hypoparathyroidism to zero. ANZ J Surg 69:794–797CrossRefGoogle Scholar
  22. 22.
    Kikumori T, Imai T, Tanaka Y (1999) Parathyroid autotransplantation with total thyroidectomy for thyroid carcinoma: long term follow-up of grafted parathyroid function. Surgery 124:504–508CrossRefGoogle Scholar
  23. 23.
    Funahashi H, Satoh Y, Imai T (1993) Our technique of parathyroid autotrasplantation in operation ofor papillary thyrois carcinoma. Surgery 114:92PubMedGoogle Scholar
  24. 24.
    Hichey RC, Samaan NA (1975) Human parathyroid autotransplantation: proved function by radioimmunoassay of plasma parathyroide hormone. Arch Surg 110:892–895CrossRefGoogle Scholar
  25. 25.
    Walgenbach S, Hommel G, Junginger T (1998) Prospective evaluation of parathyroid graft function after total parathyroidectomy and heterotopic autotransplantation in renal hyperparathyroidism by bilateral determination of intact parathormone in cubital venous blood. World J Surg 22:93–98. doi: 10.1007/s002689900355 PubMedCrossRefGoogle Scholar
  26. 26.
    Kinnaert P, Salmon I, Decoster-Gervy C (2000) Long-term results of subcutaneous parathyroid grafts in uremic patients. Arch Surg 135:186–190PubMedCrossRefGoogle Scholar
  27. 27.
    Yoon JH, Nam HK, Chang HS, Chung WY, Park CS (2006) Total parathyroidectomy and autotransplantation by the subcutaneous injection technique in secondary hyperparathyroidism. Surg Today 36:304–307PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Giuseppe Cavallaro
    • 1
    Email author
  • Olga Iorio
    • 1
  • Marco Centanni
    • 1
  • Natale Porta
    • 1
  • Angelo Iossa
    • 1
  • Lucilla Gargano
    • 1
  • Susanna Del Duca
    • 1
  • Angela Gurrado
    • 2
  • Mario Testini
    • 2
  • Vincenzo Petrozza
    • 1
  • Gianfranco Silecchia
    • 1
  1. 1.Department of Medico-Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
  2. 2.Department of Biomedical Sciences and Human OncologyUniversity of BariBariItaly

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