The Efficacy And Feasibility Of Inferior Parathyroid Gland Transplantation In Total Thyroidectomy With Central Lymph Node Dissection

Objective The aim of this study was to evaluate the efficacy and feasibility of inferior parathyroid gland transplantation in total thyroidectomy with central lymph node dissection.Methods We retrospectively collected and analyzed the clinicopathological data of 166 patients who underwent total thyroidectomy with central lymph node dissection in the Second Affiliated Hospital of Fujian Medical University from 2016 to 2019.The superior parathyroid gland was retained in the original site intraoperatively in all patients.Patients were divided into three groups according to the number of inferior parathyroid transplantation,including 58 cases of non-transplantation patients(A group),61 cases of patients with only one inferior parathyroid transplantation(B group),and 47 cases of patients with two inferior parathyroid glands transplantation(C group).The clinicopathological characteristics,preoperative serum calcium and PTH level,serum calcium and PTH level at 1,3,7,14,and 30 days after surgery,and the incidence rate of hypoparathyroidism among these three groups were analyzed and compared.Results There was no significant difference among these three groups in terms of age,gender,T stage,the invasion of the membrane of thyroid,the presence of central lymph node dissection,preoperative serum calcium,and preoperative PTH level(P>0.05).The1-day’s postoperative serum calcium in C group was significantly lower than that in A group(P<0.05);there was no significant difference among three groups with respect to the 7-day’s and 14-day’s serum calcium and PTH level(P>0.05);the 3o-day’s serum calcium and PTH level in C group was significantly higher than that in A group(P<0.05).The incidence of temporary hypoparathyroidism in group A,B,and C was43.10%,52.46%,and 68.09%,respectively.The incidence of permanent hypoparathyroidism in group A,B,and C was 3.45%,1.64%,and 0%.There was no significant difference between group C and group A in terms of the incidence of permanent hypoparathyroidism(P>0.05).The results of one-way ANOVA showed that the number of central lymph node metastasis and dissection was positively correlated with the number of inferior parathyroid gland transplantation(P<0.05).Conclusion Patients with two inferior parathyroid glands transplantation have quicker recovery rates of serum calcium and PTH levels,and less permanent hypoparathyroidism.In addition,it can help surgeons to perform central lymph node dissection more thoroughly.Routine transplantation of two inferior parathyroid glands may be the best treatment strategy for patients undergo total thyroidectomy with bilateral central lymph node dissection.