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Parathyroid Transplantation

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Parathyroid Gland Disorders

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Abstract

Parathyroid identification and preservation in-situ with good vascular supply is the mainstay of safe thyroid surgery. However, if the parathyroid glands (PTGs) are damaged, incidentally removed, or their blood supply is jeopardized, auto-transplantation should be undertaken to preserve their function. Parathyroid transplantation can be considered in three distinct modes of application: fresh parathyroid tissue auto-transplantation during thyroidectomy to reduce the risk of permanent hypoparathyroidism, cryo-preserved parathyroid tissue auto-transplantation in patients with permanent hypocalcemia, and parathyroid allo-transplantation in patients with permanent hypoparathyroidism when cryo-preserved parathyroid tissue is not available for grafting. Allo-transplantation of cultured parathyroid cells without immuno-suppression should be taken into consideration in selected patients as an alternative to treatment with calcium and vitamin D3 for permanent hypoparathyroidism. Functional viability of PTGs may best be assessed by visual inspection and the use of intra-operative parathyroid hormone. An approach of selective auto-transplantation of devascularized glands provides an effective means of restoring parathyroid function and is protective against permanent hypoparathyroidism. Some centers utilize “routine” auto-transplantation to reduce the risk of permanent hypoparathyroidism. Novel fluorescence techniques to aid in parathyroid detection during thyroid surgery are under evaluation. Transplantation of macro-encapsulated parathyroid cells may become the method of choice in the treatment of severe forms of hypoparathyroidism.

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  1. Faculty of Medicine, University of Alexandria, Alexandria, Egypt

    Mahmoud F. Sakr

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Sakr, M.F. (2022). Parathyroid Transplantation. In: Parathyroid Gland Disorders. Springer, Cham. https://doi.org/10.1007/978-3-031-07418-9_15

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