Paloyan E

Parathyroid Autotransplantation in Patients Undergoing a Total Thyroidectomy: A Review of 261 Patients

Parathyroid autotransplantation was first described in 1907 by Halsted. However, this simple and effective method of preserving parathyroid function has been used with increasing frequency only during the past 25 years. Beginning in the late 1960s, our group has transplanted normal parathyroid tissue into the ipsilateral sternocleidomastoid muscle whenever these glands could not be preserved in situ with adequate blood supply. In addition, if the blood supply of all four parathyroid glands appeared compromised, cryopreservation of parathyroid tissue was performed in case the autotransplanted tissue did not function after surgery. Since 1970, 393 patients underwent a total thyroidectomy. Parathyroid glands that could not be saved in situ were biopsied to confirm their identity by frozen section and then autotransplanted. Of the 393 patients who underwent a total thyroidectomy, 261 patients required transplantation of one or more glands. Among those 261 patients who underwent selective parathyroid autotransplantation, 33 (13%) required temporary calcium and vitamin D supplementation. Of these 33 patients, 2 (less than 1%) had permanent hypoparathyroidism and are receiving long-term vitamin D therapy.

Prior irradiation and the development of coexistent differentiated thyroid cancer and hyperparathyroidism

Twelve patients with coexistent well‐differentiated thyroid carcinoma and primary hyperparathyroidism were studied to determine the frequency of previous radiation exposure. Eight were found to have received prior irradiation. External radiation was administered to the head and neck region for benign conditions such as tonsillar enlargement, acne, scrofula, and thyroid enlargement. One patient received 131I therapy for carcinoma of the thyroid. The observation that 67% of the patients in this series had previous radiation to the head and neck strongly implicates radiation exposure in the development of coexistent well‐differentiated thyroid carcinoma and hyperparathyroidism.

Successful canine adrenal autotransplantation.

Abstract Successful canine adrenal autotransplantation has been accomplished by means of an ovarian pedicle graft. Long-term survival, normal circulating cortisol, and a positive response of circulating cortisol to ACTH stimulation was observed in four of six dogs following three operative procedures staged at 4-week intervals: (1) construction of a pedicle between the left adrenal and the left ovary, (2) excision of the contralateral adrenal (right), and (3) division of all attachments of the left adrenal gland except for the ovarian pedicle.