Trial of thyroid auto-transplantation after total thyroidectomy in benign thyroid diseases

Abstract

Background: Thyroid auto transplantation was introduced after the success of parathyroid auto transplantation. Heterotopicthyroid autotransplantation is a technique that preserves viable thyroid tissue in the body after total thyroidectomy, whichmay revascularize and restore thyroid function.Thyroid autotransplantation can help avoid lifetime thyroid hormone replacement therapy, which may have somedrawbacks such as disruption of lipid metabolism, coronary heart disease, non-compliance, and malabsorptionThyroidautotransplantation can also preserve the inner auto-regulatory mechanism of thyroid hormone production, which canadjust to the body’s needsThyroid autotransplantation can prevent reoperation at the site of previous neck surgery in casesof recurrent goiters or hyperthyroidism, which can be associated with a high rate of complications. heterotopic thyroidautotransplantation is still not a popular technique and there is limited data on its long-term outcomes and safety. Somestudies have reported satisfactory results in terms of survival and function of the thyroid implant, but the number ofpatients and the follow-up periods were very low. There are also some challenges and controversies regarding the optimalsite, size, and number of the grafts, as well as the indications and contraindications of this procedure.Aim & Objectives: To ascertain the efficacy of auto transplantation of thyroid graft after total thyroidectomy (TT) forbenign simple multi nodular goiter.Study period: 24 Months from January 2022 to January 2023 (including 12 months postoperative follow up).Patients and Methods: The study will enroll 30 patients with benign nodular goiter who will undergo total thyroidectomyand heterotopic thyroid autotransplantation in the vastus lateralis muscle of the thigh. The follow-up protocol includesmeasurement of serum levels of T3, T4, and TSH and thyroid scintigraphy using 99mTc-MIBI.Results: The study population consisted of 73.3% females and 26.7% males with a mean age of 33 years. . The meanduration of surgery was 133.47 min. One month after surgery, duplex ultrasonography showed positive graft uptakein 73.3% of patients and negative uptake in 26.7% of patients. Radioactive iodine scintigraphy showed positive graftfunction in 80% of patients after 12 months. Euthyroidism was achieved in 80% of patients 12 months after surgery,while 6.6% of patients had poor outcomes and required full-dose hormone replacement therapy and 13.3% of patientshad partial outcomes and required low-dose levothyroxine supplementation to attain euthyroidism. (levothyroxine 50).Conclusion: Heterotopic thyroid autotransplantation is a feasible, effective, and efficient procedure after totalthyroidectomy for benign thyroid disorders.