Objective: Post-surgical hypoparathyroidism (PoSH) usually settles within few months after thyroid surgery, but several require long-term supplementation with calcium/activated vitamin D. When PoSH persists beyond 6 months, it is considered ‘chronic’ or ‘permanent’, however, late recovery has been reported. The aim of this study was to determine the frequency of late recovery and explore factors predicting late recovery of parathyroid function. Methods: Adult patients undergoing total/completion thyroidectomy between 2009-18 were included in this retrospective cohort observational study. The records of patients with evidence of PoSH were reviewed to identify those with persisting PoSH at 6 months. Demographic, biochemical, surgical, pathological, and clinical follow-up data was collected and analysed. Results: Out of 911 patients undergoing thyroidectomy, 270 were identified with PoSH. Of these, 192 were started on supplements and 138 (71.9%) recovered within six months. Of the remaining 54 patients, 35 had ongoing PoSH with median (range) follow-up of 3.4 (0.5-11.1) years. Nineteen patients were weaned off supplements and achieved remission at median (range) follow-up of 1.3 (0.6-4.8) years. All of those who recovered had a PTH of ≥1.6 pmol/L at 6 months. There was no difference in age, gender, diagnosis, type, and extent of surgery between those who did and did not show late recovery. Conclusions: Recovery from PoSH is common beyond 6 months, raising question whether 6-month threshold to define ‘long term’ PoSH is appropriate. The chances of recovery are high (~50%) in patients with PTH level ≥1.6 pmol/L at 6 months, where attempts at weaning may be focussed.
Aims Post-surgical hypoparathyroidism (PoSH) is common after thyroidectomy. Most cases recover within 6 months. If persistent beyond 6 months, PoSH is considered to be ‘long term’ as per BAETS guidelines. The aim of the study is to determine the frequency of late recovery in this group and factors that can predict this. Methods Adult patients undergoing total or completion thyroidectomy between 2009–18 were included in this cohort prospective observational study. Records of patients who met certain inclusion criteria (started on calcium or activated vitamin D, or day 1 adjusted calcium <2.1 mmol/L, or day 1 PTH <1.6 pmol/L) were reviewed to identify those with PoSH at 6 months. Demographic, biochemical, surgical, pathological and clinical follow-up data is described and analysed. Results Out of 911 patients undergoing thyroidectomy, 270 met the inclusion criteria. Of these, 192 were started on supplements and 138 (71.9%) recovered within six months. Of the remaining 54 patients, 19 (47.5%) had remission and 21 had ongoing PoSH beyond 3 years follow-up (median follow-up 4.5 years). All of those recovered had a PTH of ≥1.6 pmol/L at/beyond 6 months. There was no difference in age, gender, diagnosis, extent of surgery, or calcium levels between the two groups. Conclusions Recovery from PoSH is common beyond 6 months, raising the question of whether the 6-month threshold is appropriate. In patients with a PTH level of ≥1.6 pmol/L at/after 6 months, the chances of recovery are high (60%).
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