Parathyroid autotransplantation for inadvertently resected or devascularized glands during total thyroidectomy: large retrospective cohort study.

BACKGROUND: Although recent guidelines recommend parathyroid autotransplantation for inadvertent excision of ischaemic glands, its benefit for the recovery of parathyroid function after total thyroidectomy remains uncertain. METHODS: This 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). RESULTS: Of 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. CONCLUSIONS: Parathyroid 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.