Postoperative hypoparathyroidism: medical and surgical therapeutic options

Hypoparathyroidism occurs when the parathyroid glands, through lack of secretion of or resistance to parathyroid hormone (PTH), are unable to maintain calcium homeostasis. Transient and permanent hypoparathyroidism are most commonly seen as complications of neck surgery, resulting from devascularization of the parathyroids, unintentional resection, or accidental coagulation of the parathyroids.

Although strategies for treatment of transient and permanent hypoparathyroidism differ, the classical approach involves supplementation with calcium and vitamin D or its analogues with the major goal of achieving low normal serum calcium and normal serum phosphorus. There are a variety of calcium and vitamin D preparations available for use in the treatment of symptomatic hypoparathyroidism. In selecting the appropriate vitamin D sterol for treatment, it is important to consider the pharmocodynamics, the potency at the tissue level, the rapidity of action, and ease of reversal of toxicity. Drawbacks to conventional therapy, including narrow therapeutic window and propensity for hypercalciuria and hypercalcemia, have prompted investigation into alternatives, namely PTH replacement and parathyroid gland autotransplantation.

Long-term supplementation with vitamin D or its analogues and oral calcium is the mainstay of management of postoperative hypoparathyroidism; however, PTH replacement strategies with either PTH or parathyroid gland autotransplantation are emerging as alternative strategies to avoid the complications of conventional therapy.