Thyroid autotransplantation following total thyroidectomy in benign thyroid disorders: a new technique to avoid postoperative hypothyroidism

Background: Although total thyroidectomy has become the operation of choice in treatment of BMNG, it leads to permanent hypothyroidism which lead the patient to take a lifelong exogenous hormone replacement therapy, which involves daily administration of levothyroxine at a dose that must be in close follow-up in terms of thyroid hormone levels. In addition, reaching euthyroid status using hormone replacement therapy can be affected in  presence of other medical problems that interfere with absorption of the drug as mal-absorption syndrome. When all these are considered, there is a necessity of a novel method to avoid the occurrence of postoperative hypothyroidism.Methods: A case series prospective study carried out over 30 patients with benign thyroid disorders for whom total thyroidectomy is indicated to evaluate the capacity of auto-implanted thyroid tissue in achieving an euthyroid state without any need for life-long hormone replacement therapy. Postoperative Assessment consists of repeated thyroid function tests and thyroid scan with complementary SPECT/CT.Results: significant gradual increase in serum levels of T3 and T4 with corresponding decrease in TSH levels returning to normal levels 6-9 months postoperatively. Thyroid scan with complementary SPECT/CT was done for 15 patients to evaluate the functional capacity of the thyroid implant.  Among the 15 patients, 13 patients have functioning thyroid implant (success percent: 6.6%). whereas 2 patients show non functioning thyroid implant (failure percent: 13.3%).Conclusions: Thyroid Auto-transplantation following total thyroidectomy in benign thyroid disorders is an effective method to prevent postoperative hypothyroidism.