Thyroid and Parathyroid Transplantation

After total thyroidectomy, thyroid autotransplantation (TATx) helps avoid life-time thyroid hormonal replacement therapy, with the advantage of preserving the inner autoregulatory mechanism of thyroid hormone production, according to human body needs. In addition, heterotopic thyroid auto-Tx was proposed to avoid reoperation at the site of previous neck surgery in cases of recurrent goiters or recurrent hyperthyroidism. Heterotopic TATx is a safe and easy technique that provides survival and function of the thyroid graft and achieves a postoperative euthyroid state in most cases without the need for further thyroxin replacement therapy. The degree of graft function is affected by age of the patient, preoperative pathology, weight of transplanted tissue, and operative time of the process. If the parathyroid glands are damaged, incidentally removed or their blood supply is jeopardized during thyroid surgery, parathyroid autotransplantation (PATx) should be undertaken to preserve their function. Modes of application include fresh PATx during thyroidectomy, cryopreserved parathyroid tissue auto-Tx in patients with permanent hypocalcemia, and parathyroid allo-Tx in patients with permanent hypoparathyroidism when cryopreserved parathyroid tissue is not available. Allo-Tx of cultured parathyroid cells without immunosuppression should be taken into consideration in selected patients.