Medical Management Of Postsurgical Hypoparathyroidism

      ABSTRACT

      Objective

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

      Methods

      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.

      Results

      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.

      Conclusions

      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. (Endocr Pract. 2011;[Suppl 1]17:18-25)
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      Linked Article

      • Correction
        Endocrine Practice Vol. 17Issue 6
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          In the online review article by Khan, Waguespack, and Hu entitled “Medical Management of Postsurgical Hypoparathyroidism,” which was published as part of an online supplement on the Parathyroid Glands [Endocr Pract. 2011;17(suppl 1):18-25], Table 1 (on page 23) contains an error. For ergocalciferol (under the centered heading “Vitamin D supplements”), the dosage should be 25,000-100,000 IU orally daily (not weekly) (Shoback D. N Engl J Med. 2008;359:391-403; Walker Harris V, Jan De Beur S. Thyroid.
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