TITLE:
Parathyroid Preservation in Open Thyroid Surgery
AUTHORS:
Lei Tang, Chuanchang Yin
KEYWORDS:
Thyroidectomy, Parathyroid Preservation, Hypoparathyroidism, Hypocalcemia, Near-Infrared Autofluorescence, Indocyanine Green, Autotransplantation
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.14 No.11,
November
4,
2026
ABSTRACT: Parathyroid dysfunction after thyroidectomy can occur even when the glands have been left in place, because dissection may interrupt their blood supply. This narrative review considers how that risk can be reduced during adult open thyroid surgery, particularly total and completion thyroidectomy. It covers relevant anatomy, operative technique, imaging, autotransplantation, and postoperative care. Capsular dissection allows thyroidal branches to be divided while parathyroid vessels are retained. Anatomical and observational evidence supports this approach, although direct trials of its long-term functional benefit are scarce. The need for bilateral resection or central neck dissection should be established before exposing additional glands to injury. Near-infrared autofluorescence can help identify parathyroid tissue; indocyanine green angiography provides information about perfusion. Neither measures hormone secretion. Trials of autofluorescence have yielded inconsistent functional results, despite pooled evidence of less early hypocalcemia and fewer inadvertently excised glands. Selective autotransplantation offers a means of salvaging benign tissue that has been removed or clearly devascularized. The benefit of routinely transplanting an otherwise viable gland remains uncertain. After surgery, early parathyroid hormone measurements help guide supplementation and the intensity of follow-up. Low early values often require treatment and surveillance, but chronic postsurgical hypoparathyroidism is defined by persistence beyond 12 months. Assessment of recovery, including supervised adjustment of supplements, is therefore part of care. Preserving circulation during surgery and documenting subsequent function remain the basis for judging whether a preservation technique benefits patients.