{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:25:32Z","timestamp":1787030732380,"version":"build-2736575974"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"\n Background<\/jats:title>\n Surgery remains the foundation of differentiated thyroid cancer management. However, total thyroidectomy (TT) with lymph node dissection frequently predisposes patients to hypoparathyroidism (HypoPT). The sternocleidomastoid is the conventional site for parathyroid autotransplantation, but this approach cannot effectively assess graft viability and real-time functional monitoring.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Two sequential experiments were conducted. In Experiment 1, graft survival criteria were established by analyzing serum parathyroid hormone (PTH) ratios in the bilateral cephalic veins among 30 controls and 100 patients undergoing brachioradialis parathyroid autotransplantation. In Experiment 2, 180 TT patients undergoing bilateral central neck dissection were allocated into three groups (60 per group):\n in situ<\/jats:italic>\n preservation, brachioradialis, or sternocleidomastoid autotransplantation. To address confounding, propensity score matching (PSM, 1:1:1) was performed, yielding 50 well-balanced patients per group. Temporary and permanent HypoPT, and validated graft survival were evaluated.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In Experiment 1, bilateral PTH ratio \u2264 1.16 was defined as the physiological baseline, with \u2265 1.2-fold as the graft viability threshold, which showed superior 6-month survival vs the 1.5-fold standard (83% vs 74%,\n p<\/jats:italic>\n &lt; 0.05). Graft weight predicted survival (AUC = 0.654, cutoff = 28.5 mg). The brachioradialis group showed a significantly lower incidence of temporary postoperative HypoPT than the\n in situ<\/jats:italic>\n preservation and sternocleidomastoid groups on day 1 and day 3, and than the\n in situ<\/jats:italic>\n preservation group on week 1 (all\n p<\/jats:italic>\n &lt; 0.05). Permanent HypoPT rates were comparable across groups (\n p<\/jats:italic>\n &gt; 0.05). Under the 1.2-fold criterion, brachioradialis graft survival rates were significantly higher than those at 1.5-fold criterion on day 1, 3 and week 1 (all\n p<\/jats:italic>\n &lt; 0.05). These findings were confirmed by PSM analysis.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Brachioradialis parathyroid autotransplantation is safe and effective, while significantly reducing the risk of early postoperative HypoPT. Brachioradialis autotransplantation were recommended for compromised or inadvertently excised parathyroid glands.<\/jats:p>\n <\/jats:sec>\n \n Clinical trial registration<\/jats:title>\n \n https:\/\/www.chictr.org.cn\/bin\/home<\/jats:ext-link>\n , identifier ChiCTR2400080970.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fendo.2026.1852443","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:28:05Z","timestamp":1787027285000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Parathyroid autotransplantation into the brachioradialis protects parathyroid function during total thyroidectomy"],"prefix":"10.3389","volume":"17","author":[{"given":"Shuang","family":"Wang","sequence":"first","affiliation":[{"name":"The Fourth Department of General Surgery, Second Affiliated Hospital, Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingming","family":"Liu","sequence":"additional","affiliation":[{"name":"The Fourth Department of General Surgery, Second Affiliated Hospital, Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Wu","sequence":"additional","affiliation":[{"name":"The Fourth Department of General Surgery, Second Affiliated Hospital, Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhan","family":"Gao","sequence":"additional","affiliation":[{"name":"The Fourth Department of General Surgery, Second Affiliated Hospital, Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huadong","family":"Qin","sequence":"additional","affiliation":[{"name":"The Fourth Department of General Surgery, Second Affiliated Hospital, Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenlei","family":"Shi","sequence":"additional","affiliation":[{"name":"The Fourth Department of General Surgery, Second Affiliated Hospital, Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-020-01342-1","article-title":"Recurrence-free survival after total thyroidectomy and lobectomy in patients with papillary thyroid microcarcinoma","volume":"44","author":"Van Gerwen","year":"2021","journal-title":"J Endocrinol Invest"},{"key":"B2","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1177\/10507256251363120","article-title":"2025 American Thyroid Association Management Guidelines for adult patients with differentiated thyroid cancer","volume":"35","author":"Ringel","year":"2025","journal-title":"Thyroid"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-008-0366-7","article-title":"Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients","volume":"393","author":"Bergenfelz","year":"2008","journal-title":"Langenbecks Arch Surg"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2022.03.011","article-title":"Proactive exploration of inferior parathyroid gland using a novel meticulous thyrothymic ligament dissection technique","volume":"48","author":"Wang","year":"2022","journal-title":"Eur J Surg Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2015.33.15_suppl.e17048","article-title":"Potential role for carbon nanoparticles identification and preservation in situ of parathyroid glands during total thyroidectomy and central compartment node dissection","volume":"8","author":"Gu","year":"2015","journal-title":"Int J Clin Exp Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"23352","DOI":"10.1038\/s41598-025-07289-8","article-title":"The clinical application of mitoxantrone hydrochloride tracing in endoscopic radical resection of thyroid carcinoma","volume":"15","author":"Cheng","year":"2025","journal-title":"Sci Rep"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.21037\/gs.2017.09.15","article-title":"Short and long-term impact of parathyroid autotransplantation on parathyroid function after total thyroidectomy","volume":"6","author":"Hicks","year":"2017","journal-title":"Gland Surg"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/jso.2930460106","article-title":"Parathyroid autotransplantation during thyroid surgery","volume":"46","author":"Shaha","year":"1991","journal-title":"J Surg Oncol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2017.0309","article-title":"American Thyroid Association Statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults","volume":"28","author":"Orloff","year":"2018","journal-title":"Thyroid"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-020-02324-2","article-title":"Diagnosis and management of hypocalcemia","volume":"69","author":"Pepe","year":"2020","journal-title":"Endocrine"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.136.12.1381","article-title":"Parathyroid autotransplantation during thyroidectomy: documentation of graft function","volume":"136","author":"Lo","year":"2001","journal-title":"Arch Surg"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.issn.1674-4756.2019.24.007","article-title":"Efficacy observation of radical thyroidectomy combined with parathyroid autotransplantation for thyroid carcinoma","volume":"46","author":"Zhang","year":"2019","journal-title":"Chin J Pract Med"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s12565-011-0111-0","article-title":"Parathyroid gland anatomical distribution and relation to anthropometric and demographic parameters: a cadaveric study","volume":"86","author":"Hojaij","year":"2011","journal-title":"Anat Sci Int"},{"key":"B14","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1007\/s00423-019-01751-8","article-title":"The prevalence and anatomy of parathyroid glands: a meta-analysis with implications for parathyroid surgery","volume":"404","author":"Taterra","year":"2019","journal-title":"Langenbecks Arch Surg"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1007\/s12565-012-0142-1","article-title":"Location, number and morphology of parathyroid glands: results from a large anatomical series","volume":"87","author":"Lappas","year":"2012","journal-title":"Anat Sci Int"},{"key":"B16","doi-asserted-by":"publisher","first-page":"230","DOI":"10.3978\/j.issn.2305-5839.2015.08.20","article-title":"Expert consensus statement on parathyroid protection in thyroidectomy","volume":"3","author":"Zhu","year":"2015","journal-title":"Ann Transl Med"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2012-0011","article-title":"Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature","volume":"22","author":"Giordano","year":"2012","journal-title":"Thyroid"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000005148","article-title":"Enhanced identification and functional protective role of carbon nanoparticles on parathyroid in thyroid cancer surgery: a retrospective Chinese population study","volume":"95","author":"Shi","year":"2016","journal-title":"Med (Baltimore)"},{"key":"B19","article-title":"The transplantation of parathyroids in partial thyroidectomy","volume":"62","author":"Lahey","year":"1926","journal-title":"Surg Gynecol Obstet"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2025.1565581","article-title":"Selective parathyroid autotransplantation prevent permanent hypoparathyroidism after total thyroidectomy with central neck dissection","volume":"12","author":"Sun","year":"2025","journal-title":"Front Surg"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2482-14-26","article-title":"Total parathyroidectomy with trace amounts of parathyroid tissue autotransplantation as the treatment of choice for secondary hyperparathyroidism: a single-center experience","volume":"14","author":"He","year":"2014","journal-title":"BMC Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/b978-0-407-02317-8.50008-2","article-title":"Transplantation of the parathyroid glands in man: clinical indications and results","volume":"78","author":"Wells","year":"1975","journal-title":"Surgery"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-015-3070-0","article-title":"Parathyroid reimplantation in forearm subcutaneous tissue during thyroidectomy: a simple and effective way to avoid hypoparathyroidism","volume":"39","author":"Cavallaro","year":"2015","journal-title":"World J Surg"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.asjsur.2022.08.078","article-title":"Autologous parathyroid gland in left-brachioradialis transplantation: a single-center study and long-term follow-up","volume":"46","author":"Li","year":"2023","journal-title":"Asian J Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1007\/s10856-005-0523-2","article-title":"Towards a medically approved technology for alginate-based microcapsules allowing long-term immunoisolated transplantation","volume":"16","author":"Zimmermann","year":"2005","journal-title":"J Mater Sci - Mater Med"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1053\/j.jrn.2010.01.004","article-title":"Roles of calcium-sensing receptor and vitamin d receptor in the pathophysiology of secondary hyperparathyroidism","volume":"20","author":"Mccann","year":"2010","journal-title":"J Ren Nutr"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1530\/eje-15-1028","article-title":"Genetics in endocrinology: Gain and loss of function mutations of the calcium-sensing receptor and associated proteins: current treatment concepts","volume":"174","author":"Mayr","year":"2016","journal-title":"Eur J Endocrinol"},{"key":"B28","article-title":"A new mutation in the calcium-sensing receptor gene causing hypocalcaemia: case report of a father and two sons","volume":"75","author":"Schoutteten","year":"2017","journal-title":"Neth J Med"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/bs.pmbts.2022.06.014","article-title":"Recent advances in calcium-sensing receptor structures and signaling pathways","volume":"195","author":"Gorvin","year":"2023","journal-title":"Prog Mol Biol Transl Sci"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2017.01.117","article-title":"Parathyroid reimplantation with PR-FaST technique in unselected patients during thyroidectomy. A case series with long term follow up confirming graft vitality and parathormone production","volume":"39","author":"Cavallaro","year":"2017","journal-title":"Int J Surg"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1852443\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:28:08Z","timestamp":1787027288000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1852443\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":30,"alternative-id":["10.3389\/fendo.2026.1852443"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1852443","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]},"article-number":"1852443"}}