AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: POSTOPERATIVE HYPOPARATHYROIDISM--DEFINITIONS AND MANAGEMENT

Postsurgical hypoparathyroidism is the most common and often the most troubling long-term consequence of aggressive thyroid surgery. The manipulation of the parathyroid glands, even without their removal, can lead to transient disruption of PTH production and/or release. Manipulation of the parathyroid glands in both thyroid beds is precisely the reason why most iatrogenic hypoparathyroidism occurs. Thus, bilateral central neck operations, including total thyroidectomy, bilateral central neck dissection, and total laryngectomy can result in hypoparathyroidism even in circumstances where the parathyroid glands themselves are identified and preserved. Hypoparathyroidism following surgery is commonly classified as temporary or permanent. The most common time marker used to delineate between these 2 conditions is 12 months following surgery. Permanent hypoparathyroidism is defined when a medical regimen is required for longer than 12 months. Patients with permanent hypoparathyroidism can be labile, difficult to manage, and experience significant morbidity; however, many can be maintained with a stable regimen of calcium and vitamin D and require occasional laboratory monitoring.