Ultrasound combined with serum parathyroid hormone for assessing autologous parathyroid graft viability after endoscopic thyroidectomy: a retrospective study

Objective: To investigate the diagnostic value of ultrasonography combined with serum parathyroid hormone (PTH) measurement in assessing the viability of autologous parathyroid grafts following endoscopic radical thyroidectomy for thyroid carcinoma. Methods: A retrospective analysis was performed on clinical data of 38 patients who underwent endoscopic unilateral radical thyroidectomy combined with autologous parathyroid transplantation at Gansu Provincial Central Hospital from January 2023 to September 2025. During surgery, parathyroid tissue was transplanted into the brachioradialis muscle of the forearm using the homogenate injection method. Postoperatively, PTH concentration ratios in blood samples from both antecubital fossae and ultrasonographic images of the graft site were periodically evaluated to assess graft viability. Results: Parathyroid hormone concentration on the transplantation side increased persistently after surgery, reaching a peak at 3 months postoperatively, with a significant elevation in the PTH ratio (28.89-fold) compared to the systemic circulation. Thereafter, the ratio gradually declined but consistently remained >1.5-fold. Ultrasonography performed at 3 months postoperatively revealed hypoechoic nodules of approximately 3 mm in diameter at the graft site in some patients, with punctate blood flow signals detected by color Doppler flow imaging (CDFI). Conclusion: The combination of ultrasonography and serum PTH concentration ratio provides objective imaging and biochemical evidence for parathyroid graft viability following autologous transplantation, facilitating more accurate assessment of functional recovery of the graft.