Primary prevention
The best way to avoid hypoparathyroidism caused by unintended surgical removal or damage would be to avoid any injury to the parathyroids or their blood supply. This can be done by meticulous surgical dissection.[23] The problem is a lot less likely when an experienced surgeon is performing the operation. The temporary problem of hypoparathyroidism with distressing hypocalcemia may be prevented by temporary preemptive treatment with calcium and/or calcitriol for a period when temporary hypocalcemia is a distinct risk.[24][25] Some surgeons have begun to use near infrared autofluorescence (NIRAF) detection, by imaging or probe, or indocyanine green perfusion, to identify and preserve the parathyroid glands intraoperatively.[26]
Secondary prevention
Postsurgical hypoparathyroidism: during extensive surgery of the thyroid and/or parathyroid glands, the remaining parathyroid gland(s) should be identified but left undisturbed as much as possible and their blood supply not disrupted. Each gland identified should be viewed as if it were the patient's last gland. If a parathyroid gland is devascularized during surgery inadvertently, it can be fragmented and implanted into the sternocleidomastoid muscle, anticipating that within a few weeks it will acquire a blood supply and begin to function.
In cases of primary parathyroid hyperplasia or uremic secondary or tertiary hyperparathyroidism, the surgeon endeavors to leave behind a gland remnant with intact vasculature large enough to support parathyroid hormone needs. In cases of primary parathyroid hyperplasia, the number of glands that are removed may depend on the etiology, with fewer glands typically removed for multiple endocrine neoplasia (MEN)2 and a greater number of glands (subtotal or 3.5 gland parathyroidectomy favored) for MEN1. Another alternative is total parathyroidectomy and autotransplantation of parathyroid tissue to the brachioradialis, or subcutaneously in the forearm. Each case is managed individually with a view of the genetic etiology of the hyperparathyroidism in mind.[41]
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