The Management of Parathyroid In Vitro During Thyroid Surgery

Objective: In addition to parathyroid in vivo preservation, parathyroid autotransplantation is another important remedial method in vitro for patients whose parathyroid glands have been devascularized or inadvertently removed during thyroid surgery. This video demonstrates our experience of the management of parathyroid during thyroid surgery, by describing our methods of intraoperative confirmation and implantation as well as postoperative evaluation of the function of transplanted parathyroid.1,2 Methods: We demonstrate parathyroid autotransplantation, in case of any parathyroid gland found to be insufficient in blood supply or been inadvertently excised during the operation.3,4 We routinely take the following "SCIE" procedure. Slice the graft into 0.1–0.2 mm pieces in 2 mL of 0.9% normal saline in a 10-mL syringe. Confirm the graft with 2 drops of suspension liquid using the rapid parathyroid hormone (PTH) immunochromatographic strip (Bioda Biotechnology c., LTD.), in which PTH was measured by using an immune colloidal gold-based technique. Inject the graft into the left forearm muscle through an 18-gauge needle.5Evaluate the function of transplanted parathyroid glands by comparing PTH concentrations between the grafted and nongrafted forearms at 2 weeks and 2 months after surgery. Results: The entire "SCIE" procedure took ~3 minutes in all cases. Compared with the intraoperative pathologic examination, the qualitative PTH test strip had a sensitivity of 96.2% and a specificity of 100% in intraoperative screening for the parathyroid gland.1 The PTH ratio ≥2 in the grafted arm relative to the nongrafted arm was observed in 95% of patients.6 Conclusion: The PTH test strip is a reliable, time-saving, and easy-to-perform method, allowing rapid confirmation of parathyroid glands. The forearm autotransplantation using the intramuscular injection technique is a natural, safe, and mini-invasive procedure. The evaluation of serum PTH between grafted and nongrafted forearms is considered as a proper and accurate way to detect the function of the graft. In summary, the "SCIE" procedure for the management of parathyroid in vitro is an effective method for parathyroid protection that can help avoid or minimize the risk for postoperative hypoparathyroidism. Acknowledgments: The PTH test strip was first reported by Professor Xin-Rui Li in the Department of Breast and Thyroid Surgery, Tongji Medical College, Huazhong University of Science and Technology of Wuhan in Chinese thyroid surgery meetings in 2017. Many thanks to the friendship of Professor Gregory Randolph, Dipti Kamani, Ayaka Iwata, and Okenwa Okose in Massachusetts Eye and Ear Infirmary, Harvard Medical University. Funding: This research was supported by the Joint Funds for the Innovation of Science and Technology, Fujian Province (Grant Nos. 2018Y9093, 2018Y0915, and 2018Y9018); The Health Research Talents Training Project of Fujian Province (Grant Nos. 2019-CX-16 and 2018-CX-17); and the Guiding Social Development Project of Fujian Province (Grant No. 2018Y0035). Additional supporting information may be found in the online version of this article. Authors Contribution: Bo Wang called Brandon Wang in English is the chief operator of this procedure and provided the original idea of this video. Bo Wang, J.Z., J.-F.Y., J.W., Y.-J.W., M.-T.W., and Y.-F.Z. prepared the article and narration. W.-X.Z. made a critical revision of this video. No competing financial interests exist. Runtime of video: 4 mins 23 secs