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

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.