Parathyroid Gland Autotransplantation Outcomes in Pediatric Patients: A Retrospective Study

Introduction: Parathyroid gland (PG) auto-transplantation is performed to preserve the function of devascularized or unintentionally removed PGs, however, little has been published about the technique and outcomes in children. The aim of our study was to evaluate the outcomes and factors that lead to pediatric parathyroid auto-transplantation in a large, single institution.

Methods: A retrospective review identified pediatric patients ( < 18 years of age) at a single institution who underwent PG auto-transplantation after thyroidectomy or parathyroidectomy, with or without neck dissection, from January 2000 to December 2022.

Results: A total of 14 patients underwent PG auto-transplantation, with 13 patients with surgical indication of thyroidectomy and 1 parathyroidectomy. The average age of patients was 12.79 years, with 11 female patients, and 3 male. The most common site of transplantation was sternocleidomastoid (11/14) with forearm (2/14) and strap muscle (1/14) as the other sites. Half (7/14) of patients had transient postoperative hypocalcemia and 21.6% (3/14) had permanent postoperative hypocalcemia. The sternocleidomastoid reimplantation site was significantly (p=0.033) more likely to lead to normal calcium levels postoperatively than the other reimplantation sites. Thyroid cancer was the indication for surgery for 50% (7/14) and 78.6% (11/14) had concurrent neck dissections. Lateral neck dissection had statistical significance (p=0.001) for transient hypocalcemia ( < 24 hours postoperative).

Conclusions: Permanent hypocalcemia after pediatric thyroidectomy or parathyroidectomy is a devastating complication after surgery. There are limited studies of pediatric PG auto-transplantation and our study shows factors that may predict when a surgeon may considering using the technique, which may help prevent permanent hypocalcemia.