American Thyroid Association Statement on postoperative hypoparathyroidism: Diagnosis, prevention, and management in adults Journal Article


Authors: Orloff, L. A.; Wiseman, S. M.; Bernet, V. J.; Fahey, T. J. 3rd; Shaha, A. R.; Shindo, M. L.; Snyder, S. K.; Stack, B. C. Jr; Sunwoo, J. B.; Wang, M. B.; for the American Thyroid Association Surgical Affairs Committee Writing Task Force
Article Title: American Thyroid Association Statement on postoperative hypoparathyroidism: Diagnosis, prevention, and management in adults
Abstract: Background: Hypoparathyroidism (hypoPT) is the most common complication following bilateral thyroid operations. Thyroid surgeons must employ strategies for minimizing and preventing post-thyroidectomy hypoPT. The objective of this American Thyroid Association Surgical Affairs Committee Statement is to provide an overview of its diagnosis, prevention, and treatment. Summary: 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. Medical and surgical strategies to minimize perioperative hypoPT include optimizing Vitamin D levels, preserving parathyroid blood supply, and autotransplanting ischemic parathyroid glands. Measurement of intraoperative or early postoperative intact PTH levels following thyroidectomy can help guide patient management. In general, a postoperative PTH level <15 pg/mL indicates increased risk for acute hypoPT. 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. © American Thyroid Association 2018.
Keywords: paresthesia; thyroidectomy; parathyroid hormone; hypocalcemia; hypoparathyroidism; central neck
Journal Title: Thyroid
Volume: 28
Issue: 7
ISSN: 1050-7256
Publisher: Mary Ann Liebert, Inc  
Date Published: 2018-07-01
Start Page: 830
End Page: 841
Language: English
DOI: 10.1089/thy.2017.0309
PROVIDER: scopus
PUBMED: 29848235
DOI/URL:
Notes: Article -- Export Date: 1 August 2018 -- Source: Scopus
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  1. Ashok R Shaha
    698 Shaha