Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Guideline on Postoperative Hypoparathyroidism

Thyroid; ePub 2018 Jun 29; Orloff, Wiseman, et al

Hypoparathyroidism (hypoPT) is the most common complication following bilateral thyroid operations. Realizing this, the American Thyroid Association Surgical Affairs Committee Statement recently provided an overview of its diagnosis, prevention, and treatment.

HypoPT occurs when a low intact parathyroid hormone (PTH) level is accompanied by hypocalcemia. Risk factors for post-thyroidectomy hypoPT include bilateral thyroid operations, autoimmune thyroid disease, central neck dissection, substernal goiter, surgeon inexperience, and malabsorptive conditions. In general, a postoperative PTH level <15 pg/mL indicates increased risk for acute hypoPT. Key guideline highlights include:

  • Effective management of mild to moderate potential or actual postoperative hypoPT can be achieved by administering either empiric/prophylactic oral calcium and vitamin D, selective oral calcium, and vitamin D based on rapid postoperative PTH level(s), or serial serum calcium levels as a guide.
  • Monitoring for rebound hypercalcemia is necessary to avoid metabolic and renal complications.
  • For more severe hypocalcemia, inpatient management may be necessary.
  • Permanent hypoPT has long-term consequences for both objective and subjective well-being, and should be prevented whenever possible.

Orloff LA, Wiseman SM, Bernet VJ, et al, for the American Thyroid Association Surgical Affairs Committee Writing Task Force. American Thyroid Association statement on postoperative hypoparathyroidism: Diagnosis, prevention, and management in adults. [Published online ahead of print June 29, 2018]. Thyroid. doi:10.1089/thy.2017.0309.