{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T05:46:56Z","timestamp":1768456016567,"version":"3.49.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004829","name":"Science and Technology Department of Sichuan Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004829","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the clinical efficacy of the \u201c2+2\u201d strategy (preserving 2 superior glands <jats:italic>in situ<\/jats:italic> and autotransplanting 2 inferior glands) in patients with papillary thyroid carcinoma (PTC) undergoing total thyroidectomy (TT) with bilateral central lymph node dissection (BCLND), using propensity score matching (PSM) to control confounding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>A retrospective cohort of 1,099 PTC patients treated with TT+BCLND at West China Hospital (2017\u20132023) was analyzed. After 1:1 PSM, 592 patients (296 per group) were included. Outcomes included temporary hypoparathyroidism (THP), permanent hypoparathyroidism (PHP), and postoperative PTH, calcium (Ca), and vitamin D (VitD) levels. Logistic regression identified predictors of THP and PHP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After matching, baseline characteristics were comparable. The \u201c2+2\u201d group had longer operative time (150 vs. 123 min, <jats:italic>p<\/jats:italic>&amp;lt;0.01), higher THP incidence (72.97% vs. 48.31%, <jats:italic>p<\/jats:italic>&amp;lt;0.01), and lower PHP incidence (0.68% vs. 3.72%, <jats:italic>p<\/jats:italic> = 0.03). PTH and Ca levels dropped more on postoperative day 1 in the \u201c2+2\u201d group but recovered more rapidly between day 1 and month 1. By month 12, levels converged in both groups. Parathyroid autotransplantation was an independent risk factor for THP (OR = 2.476, <jats:italic>p<\/jats:italic>&amp;lt;0.01) but protective against PHP (OR = 0.139, <jats:italic>p<\/jats:italic> = 0.02). Tumor size was also associated with THP risk (OR = 1.424, <jats:italic>p<\/jats:italic> = 0.04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The \u201c2+2\u201d strategy increases short-term THP risk but significantly reduces long-term PHP. Rapid biochemical recovery supports the functional viability of autotransplanted glands. This approach may offer a safe and effective strategy for parathyroid management in high-risk thyroid surgeries.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1646573","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T04:12:22Z","timestamp":1756959142000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Propensity score-matched analysis of the \u20182+2\u2019 parathyroid strategy in total thyroidectomy with central neck 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