During total thyroidectomy for a multinodular goitre, the surgeon devascularizes a parathyroid gland and it appears dusky. What is the most appropriate immediate management?

• A Replace the gland in its anatomical position and suture the capsule
• B Autotransplant the gland into the sternocleidomastoid muscle ✓
• C Obtain an intraoperative PTH level before deciding
• D Apply papaverine-soaked gauze and wait 15 minutes for the colour to improve

Explanation

When a parathyroid gland is devascularized during thyroidectomy, immediate autotransplantation is the standard of care. The gland is sliced into 1 mm fragments and implanted into a muscle pocket (sternocleidomastoid or forearm) marked with a non-absorbable suture. This prevents permanent hypoparathyroidism. Re-implantation in the original position does not restore blood supply.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.