Permanent hypoparathyroidism following total thyroidectomy – Incidence and preventative strategies without imaging adjuncts - 12/04/25

Doi : 10.1016/j.amjsurg.2025.116196

Anita Niu ^a,^{^{1
AN and LZ are co-first authors.}}, Lydia Zhou ^a,^{^{1
AN and LZ are co-first authors.},}^⁎ , Alexander Papachristos ^a,^b, Hazel Serrao-Brown ^a, Adam Aniss ^a, Mark Sywak ^a,^b, Stan Sidhu ^a,^b
^a Department of Endocrine Surgery, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
^b Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia

^⁎Corresponding author. Royal North Shore Hospital Reserve Rd, St Leonards NSW, 2065, Australia.Royal North Shore Hospital Reserve Rd, St LeonardsNSW2065Australia

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.

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Highlights

•	pHypoPT risk after total thyroidectomy performed by high-volume surgeons is <1 %.
•	Among patients with pHypoPT, one third had recovery of PTH levels, but an ongoing calcitriol supplementation requirement.
•	On multivariate analysis, parathyroid auto-transplant independently reduced the risk of pHypoPT.

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Keywords : Permanent hypoparathyroidism, Total thyroidectomy, Parathyroid auto-transplantation