Hypoparathyroidism after thyroidectomy: prevention, assessment and management.

Abstract

Permanent hypoparathyroidism is the most common long-term complication after total thyroidectomy and it can cause significant morbidity and increased costs. Its incidence varies from 30% to 60%. The surgical technique and the extent of thyroidectomy are related to parathyroid injury and hypoparathyroidism. The glands should be identified in situ, carefully manipulated and preserved, as well as their vascularization. In case of incidental removal, routine autotransplantation is advocated. Low calcium levels, identification of fewer than two parathyroid glands at surgery, reoperation for bleeding, Graves disease and heavier thyroid specimens were considered independent predictors of permanent hypocalcemia. Intraoperative parathyroid hormone (PTH) measurements allows the early detection of hypocalcemia. Treatment is recommended for patients with symptoms of hypocalcemia or corrected serum calcium < 7.5 mg/dL. Acute hypocalcemia is treated with either oral calcium or an intravenous infusion. The goal is to preserve serum calcium in the low normal or mildly subnormal levels. Hypocalcemia symptoms should be considered a medical emergency. Treatment with PTH has been recently performed for the management of cases not adequately controlled with conventional therapy. Hypoparathyroidism is the most common long-term complication after total thyroidectomy. Adequate recognition and management decrease its morbidity and costs.