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

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. A total of 135 patients with differentiated thyroid carcinoma were analyzed (IPCP, n = 67; control, n = 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. The incidence of postoperative hypoPTH and protracted hypoPTH was not significantly different between the IPCP and control groups (50.8% vs 41.2%, p = 0.265; 6.0% vs 14.7%, p = 0.096). An exploratory analysis showed a higher rate of early PFR in the IPCP group (88.2% vs 64.3%; p = 0.025). The incidence of postoperative hypocalcemia was similar between groups (79.1% vs 82.4%; p = 0.632). Fewer inadvertent parathyroidectomy occurred in the IPCP group, though this difference was not statistically significant (4.5% vs 8.8%; p = 0.505). Other surgical complications were comparable. IPCP did not reduce postoperative hypoPTH in this randomized trial. Earlier PFR is exploratory and warrants further investigation in adequately powered trials.