Permanent hypoparathyroidism following total thyroidectomy - Incidence and preventative strategies without imaging adjuncts

Anita Niu; Lydia Zhou; Alexander Papachristos; Hazel Serrao-Brown; Adam Aniss; Mark Sywak; Stan Sidhu

doi:10.1016/j.amjsurg.2025.116196

Permanent hypoparathyroidism following total thyroidectomy - Incidence and preventative strategies without imaging adjuncts

Am J Surg. 2025 Jan 9:116196. doi: 10.1016/j.amjsurg.2025.116196. Online ahead of print.

Authors

Anita Niu¹, Lydia Zhou², Alexander Papachristos³, Hazel Serrao-Brown¹, Adam Aniss¹, Mark Sywak³, Stan Sidhu³

Affiliations

¹ Department of Endocrine Surgery, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia.
² Department of Endocrine Surgery, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia. Electronic address: [email protected].
³ Department of Endocrine Surgery, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia; Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

PMID: 39824725
DOI: 10.1016/j.amjsurg.2025.116196

Abstract

Introduction: Permanent hypoparathyroidism (pHypoPT) is the most common permanent complication of total thyroidectomy. We aim to describe the incidence and predictors of hypoparathyroidism in a consecutive series of patients treated in a high-volume centre and define strategies to reduce the risk of pHypoPT.

Methods: 1182 patients who underwent total thyroidectomy between April 2018 and June 2022 were analyzed. Temporary hypoparathyroidism (tHypoPT) was defined as PTH <0.4 pmol/L (<4 pg/mL) at day one post-operatively, or clinical or biochemical evidence of hypocalcemia. pHypoPT was defined as an ongoing need for calcitriol supplementation to maintain normocalcemia at 12 months. Symptomatic tHypoPT (OR 43.97, p < 0.001) and number of parathyroid glands in the operative specimen (OR 2.31, p = 0.022) were also significantly associated with pHypoPT.

Results: Biochemical tHypoPT occurred in 205 (17.4 %) patients whilst pHypoPT occurred in 6 (0.5 %) patients. On multivariate analysis, parathyroid auto-transplantation (PA) independently reduced the risk of pHypoPT (OR 0.04, p = 0.004).

Conclusions: The risk of pHypoPT after total thyroidectomy is 0.5 % when performed by high-volume surgeons. PA represents an important technique that reduces the risk of pHypoPT.

Keywords: Parathyroid auto-transplantation; Permanent hypoparathyroidism; Total thyroidectomy.