Impact of the amount of parathyroid autotransplantation in total parathyroidectomy for secondary hyperparathyroidism: a prospective randomized trial

This prospective randomized study evaluated the effect of the number of transplanted parathyroid fragments on parathyroid hormone (PTH) levels and clinical outcomes in total parathyroidectomy with autotransplantation for secondary hyperparathyroidism (SHPT). Patients were assigned to have either 20 or 45 fragments of parathyroid transplantation. Sixty-three patients were included in the 20-fragment group and 64 in the 45-fragment group. With calcium and vitamin D intake and serum calcium level adjustment, mean PTH levels in the 45-fragment group were higher than the 20-fragment group, with a significant difference at the 12th month (43.79 pg/mL vs. 32.82 pg/mL, p = 0.044). Mean PTH levels were within normal range in both groups at all follow-up visits, and the differences between groups gradually decreased over time. Bone pain and skin pruritus were significantly less in the 45-fragment group only at the 12th and 18th months. One patient in the 20-fragment group had recurrent hyperparathyroidism and was successfully treated with the autograft removal. Two patients in the 20-fragment and one patient in the 45-fragment group developed hypoparathyroidism. Recurrent hyperparathyroidism and hypoparathyroidism rates are low compared with previous studies. In conclusion, both 20 and 45 parathyroid fragment autotransplantation following total parathyroidectomy appear to be similarly effective for SHPT treatment. Trial registration The study was registered in the Thai Clinical Trial Registry with a Unique Identifying Number or registration ID: TCTR20210821001. (date of first registration: 27/06/2019).