POSTOPERATIVE HYPOPARATHYROIDISM - CRITICAL ANALYSIS OF A SMALL CENTER'S CASE SERIES AND PROPOSAL FOR A PERIOPERATIVE PROTOCOL ines.peixoto95@hotmail.com

 

POSTOPERATIVE HYPOPARATHYROIDISM - CRITICAL ANALYSIS OF A SMALL CENTER'S CASE SERIES AND PROPOSAL FOR A PERIOPERATIVE PROTOCOL

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Portugal

Oral or Poster

Postoperative hypoparathyroidism (POH) is a common complication after total or completion thyroidectomy, resulting in hypocalcemia due to insufficient parathyroid hormone production, which affects bone metabolism and neuromuscular function. While most cases are transient, some become permanent and require long-term supplementation.

This retrospective observational study analyzed 109 patients who underwent total or completion thyroidectomy between January 2021 and December 2022. Data on demographics, clinical characteristics, and biochemical markers were collected to evaluate the incidence, risk factors, and patterns of POH.

Surgical procedures included total thyroidectomy (67%), completion thyroidectomy (29.4%), total thyroidectomy with central compartment lymph node dissection (2.8%), and total thyroidectomy with modified radical neck dissection (0.9%). Indications for surgery were mainly malignant pathology (58.7%), multinodular goiter with compressive symptoms (31.2%), nodules with Bethesda III/IV cytology (8.3%), and Graves’ disease (1.8%). POH developed in 30.27% of patients; 19.2% were symptomatic, and 3.67% had permanent hypoparathyroidism. The remainder (26.6%) experienced transient POH lasting less than six months. Among POH cases, most underwent surgery for malignancy, and 19 patients required intravenous calcium supplementation. Risk factors identified included cervical lymph node dissection and Graves’ disease.

The incidence and risk factors observed align with existing literature. The high use of intravenous calcium was linked to the absence of a standardized treatment protocol rather than severity. The study highlights the need for standardized approaches to optimize diagnosis, prevention, and treatment of POH, thereby improving patient outcomes.