Hypoparathyroidism after total thyroidectomy: incidence and resolution

Abstract

Background Parathyroid hormone (PTH) levels are often measured after thyroid surgery and are used to detect patients at risk for postoperative hypoparathyroidism. However, there is a lack of consensus in the literature about how to define the recovery of parathyroid gland function and when to classify hypoparathyroidism as permanent. The goals of this study were to determine the incidence of low postoperative PTH in total thyroidectomy patients and to monitor their time course to recovery of parathyroid gland function. Methods We identified 1054 consecutive patients who underwent a total or completion thyroidectomy from 1/2006 to 12/2013. Low PTH was defined as a PTH measurement <10 pg/mL immediately after surgery. Patients were considered to be permanently hypoparathyroid if they had not recovered within 1 year. Recovery of parathyroid gland function was defined as PTH ≥10 pg/mL and no need for therapeutic calcium or activated vitamin D (calcitriol) supplementation to prevent hypocalcemic symptoms. Results Of 1054 total thyroidectomy patients, 189 (18%) had a postoperative PTH <10 pg/mL. Of those 189 patients, 132 (70%) showed resolution within 2 months of surgery. Notably, 9 (5%) resolved between 6–12 months. At 1 year, 20 (1.9%) were considered to have permanent hypoparathyroidism. Surprisingly, 50% of those patients had recovery of PTH levels yet still required supplementation to avoid symptoms. Conclusions Most patients with a low postoperative PTH recover function quickly, but it can take up to 1 year for full resolution. Hypoparathyroidism needs to be defined not only by PTH levels, but also by medication requirements.

The prevalence of post-thyroidectomy chronic asthenia: a prospective cohort study

“…Several assumptions led to this widely shared behavior. The major reasons included the following: low complication rate associated with TT (as reported by several authors) [27][28][29], risk of relapse after hemithyroidectomy [5,7], risk of an occult malignancy [30] that makes follow-up complex, and/or greater difficulty in performing the revision surgery after thyroid lobectomy. Several recent studies have emphasized various advantages of hemithyroidectomy [31,32] in selected cases of malignancy [33,34].…”

Is Morbıdıty Hıgh in Completıon Thyroıdectomy?

“…Diğer korkulan bir komplikasyon kalıcı hipoparatiroidizmdir (19)(20)(21). Literatürde geçici hipoparatiroidizm oranları %3-15 arası değişmektedir.…”

Hypocalcemia posthyroidectomy: prevention, diagnosis and management

“…Large size and weight of the thyroid gland [17,21] Retro-sternal extension of the thyroid [32] Dissection of the central neck nodal compartment [15,25,31] Re-interventions [17] Deficit or insufficiency of VD [33] Surgeon expertise [26] Graves-Basedow disease [26,31] Extent of surgery [15,34] Female sex [15,31] Presurgical use of β Blockers [31] Less than 2 PGs identified [15] Parathyroid tissue on the final pathology report [35] Predictive factors of postsurgical hypoparathyroidism:…”