A Randomized Trial Evaluating Intraoperative Ischemic Preconditioning of Parathyroid Glands During Total Thyroidectomy: A Signal for Earlier Parathyroid Function Recovery.

[BACKGROUND] Ischemic preconditioning of parathyroid glands (IPCP) is biologically plausible but clinical evidence is limited. In this single-center randomized trial (ChiCTR2000039788), we compared IPCP versus control during total thyroidectomy with central neck dissection.

[METHODS] A total of 135 patients with differentiated thyroid carcinoma were analyzed (IPCP,  = 67; control,  = 68). IPCP consists of three cycles of 60-second occlusion followed by 60-second reperfusion of the ipsilateral superior and inferior thyroid arteries. The baseline characteristics, postoperative hypoparathyroidism (hypoPTH) and hypocalcemia, early parathyroid function recovery (PFR), and surgical complications, were compared between groups.

[RESULTS] The incidence of postoperative hypoPTH and protracted hypoPTH was not significantly different between the IPCP and control groups (50.8% vs 41.2%,  = 0.265; 6.0% vs 14.7%,  = 0.096). An exploratory analysis showed a higher rate of early PFR in the IPCP group (88.2% vs 64.3%;  = 0.025). The incidence of postoperative hypocalcemia was similar between groups (79.1% vs 82.4%;  = 0.632). Fewer inadvertent parathyroidectomy occurred in the IPCP group, though this difference was not statistically significant (4.5% vs 8.8%;  = 0.505). Other surgical complications were comparable.

[CONCLUSIONS] IPCP did not reduce postoperative hypoPTH in this randomized trial. Earlier PFR is exploratory and warrants further investigation in adequately powered trials.