Medical management of postsurgical hypoparathyroidism

To provide a clinical update on the management of hypoparathyroidism with focus on postsurgical hypoparathyroidism.

Using PubMed, English-language literature was searched related to management of hypoparathyroidism after thyroid and parathyroid surgery. We discuss the incidence, pathophysiology, differential diagnosis, early diagnosis, and treatment of transient and permanent hypoparathyroidism.

Hypoparathyroidism is a well-recognized complication after thyroid and parathyroid surgery. Transient hypoparathyroidism occurs in 10% of patients who undergo total thyroidectomy. Less than half of patients who develop transient hypoparathyroidism after thyroid surgery develop permanent hypoparathyroidism. Postsurgical hypocalcemia resulting from inadequate parathyroid hormone (PTH) secretion could cause neurologic complications and respiratory compromise. Calcium supplements and vitamin D analogues effectively treat hypocalcemia associated with postsurgical hypoparathyroidism. Measurement of PTH after thyroid and parathyroid surgery allows early identification of patients likely to require calcium supplements and vitamin D analogue therapy. Early identification and appropriate management of postsurgical hypoparathyroidism prevent hypocalcemia-related complications and allow patients to be discharged from the hospital earlier. Patients who develop permanent hypoparathyroidism should receive appropriate follow-up care to monitor for long-term complications related to supplemental therapy. PTH replacement therapy is currently being evaluated for the treatment of transient and permanent hypoparathyroidism.

A multidisciplinary approach involving an endocrinologist and surgeon is imperative to reduce the morbidity associated with hypoparathyroidism after thyroid and parathyroid surgery. Supplemental therapy with calcium and vitamin D analogues is standard. New drugs currently in clinical trials offer promising treatment options.