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CLINICAL FEATURES, DIAGNOSIS, AND OPTIMIZATION OF MANAGEMENT IN
POST-THYROIDECTOMY HYPOPARATHYROIDISM
G’aniye a Mas u a Sha i jon qizi
Mas e ’s S uden , Andijan S a e Medical Ins i u e.
h ps://doi.o g/10.5281/zenodo.17670603
Abs ac . Pos - hy oidec omy hypopa a hy oidism (PH) is a common complica ion o
hy oid su ge y, o en causing hypocalcemia and educing quali y o li e. This s udy e alua ed 60
pa ien s unde going hy oidec omy o incidence, clinical ea u es, biochemical changes, and
ea men ou comes o PH. T ansien PH occu ed in 18 pa ien s (30%), and pe manen PH in 5
pa ien s (8.3%). The mos equen clinical mani es a ions we e pa es hesia (36.7%), muscle
c amps (25%), e any (6.7%), and posi i e Ch os ek o T ousseau signs (16.7%). Mean se um
calcium dec eased om 9.3 ± 0.4 mg/dL p eope a i ely o 7.2 ± 0.6 mg/dL a 24 hou s
pos ope a i ely (p < 0.01), while mean PTH d opped om 48 ± 15 pg/mL o 12 ± 6 pg/mL a 12
hou s pos ope a i ely in a ec ed pa ien s. To al hy oidec omy was associa ed wi h a highe PH
a e (35%) compa ed o sub o al hy oidec omy (15%), and p ese a ion o pa a hy oid glands
signi ican ly educed hypocalcemia isk (p < 0.05). In a enous calcium co ec ed acu e
hypocalcemia in 90% o pa ien s wi hin 24–48 hou s, and o al calcium wi h ac i e i amin D
main ained no mocalcemia in 85% a 3 mon hs. Indi idualized he apy educed ecu en
symp oms and hospi al eadmissions. Ea ly diagnosis, ca e ul su gical echnique, and ailo ed
pos ope a i e managemen a e c ucial o op imize ou comes and p e en complica ions in PH
pa ien s.
Keywo ds: pos - hy oidec omy hypopa a hy oidism, hypocalcemia, pa a hy oid ho mone,
calcium supplemen a ion, i amin D, hy oid su ge y complica ions, endoc ine managemen .
In oduc ion. Thy oidec omy, widely pe o med o benign and malignan hy oid
condi ions, ca ies a isk o pos ope a i e hypopa a hy oidism due o inad e en pa a hy oid
inju y, de ascula iza ion, o acciden al emo al. PH mani es s as acu e hypocalcemia, p esen ing
wi h numbness, pa es hesia, muscle c amps, e any, and ca diac a hy hmias [1].
Ch onic hypopa a hy oidism may lead o basal ganglia calci ica ions, ca a ac s,
neph oli hiasis, and educed bone densi y. Ea ly de ec ion and indi idualized managemen a e
essen ial o p e en complica ions and op imize ou comes [2]. Cu en diagnos ics include se um
calcium, ionized calcium, phospho us, magnesium, and PTH measu emen s, whe eas ea men
ocuses on calcium and ac i e i amin D supplemen a ion.
Objec i es:
1. To e alua e he clinical ea u es o PH a e hy oidec omy.
2. To assess he e ec i eness o biochemical ma ke s o ea ly diagnosis.
3. To p opose op imized s a egies o p e en ion and managemen o PH.
Ma e ials and me hods. A p ospec i e s udy included 60 pa ien s (48 emales, 12 males,
mean age 46 ± 12 yea s) unde going o al o sub o al hy oidec omy. Se um o al calcium, ionized
calcium, phospho us, magnesium, and PTH le els we e measu ed p eope a i ely, a 12 and 24
hou s pos ope a i ely, and a 1, 3, and 6 mon hs ollow-up. Clinical signs o hypocalcemia we e
eco ded.
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PH was classi ied as ansien i calcium le els no malized wi hin 6 mon hs and pe manen
i hypocalcemia pe sis ed beyond 6 mon hs. T ea men p o ocols included in a enous calcium
glucona e o symp oma ic hypocalcemia, ollowed by o al calcium ca bona e and al acalcidol.
S a is ical analysis e alua ed co ela ions be ween PH incidence and su gical ac o s, PTH
le els, and pa ien demog aphics.
Resul s. The incidence o pos - hy oidec omy hypopa a hy oidism in his s udy showed
ha ansien hypopa a hy oidism occu ed in 18 pa ien s, accoun ing o 30% o he coho , while
pe manen hypopa a hy oidism was obse ed in 5 pa ien s, ep esen ing 8.3%. Clinically, he mos
equen mani es a ions included pa es hesia, which was epo ed in 22 pa ien s (36.7%), ollowed
by muscle c amps in 15 pa ien s (25%).
Te any was obse ed in 4 pa ien s (6.7%), and signs such as Ch os ek o T ousseau we e
p esen in 10 pa ien s (16.7%). Biochemical assessmen e ealed ha mean se um calcium le els
dec eased om 9.3 ± 0.4 mg/dL p eope a i ely o 7.2 ± 0.6 mg/dL wi hin 24 hou s pos ope a i ely
(p < 0.01). Concu en ly, mean pa a hy oid ho mone (PTH) le els d opped om 48 ± 15 pg/mL
be o e su ge y o 12 ± 6 pg/mL a 12 hou s pos ope a i ely in pa ien s who de eloped
hypopa a hy oidism. Analysis o su gical ac o s indica ed ha o al hy oidec omy was associa ed
wi h a highe a e o hypopa a hy oidism (35%) compa ed o sub o al hy oidec omy (15%).
P ese a ion o he pa a hy oid glands du ing su ge y signi ican ly educed he incidence
o pos ope a i e hypocalcemia (p < 0.05). Rega ding ea men ou comes, in a enous calcium
adminis a ion co ec ed acu e hypocalcemia in 90% o pa ien s wi hin 24–48 hou s.
Subsequen o al supplemen a ion wi h calcium and ac i e i amin D main ained
no mocalcemia in 85% o pa ien s a he 3-mon h ollow-up. Pa ien s who ecei ed indi idualized
he apy expe ienced ewe ecu en hypocalcemic symp oms and educed a es o hospi al
eadmission.
Discussion. PH emains a signi ican complica ion o hy oid su ge y, wi h ansien o ms
mo e common han pe manen . Ea ly biochemical moni o ing using PTH and calcium le els
enables apid iden i ica ion and ea men .
Su gical echniques emphasizing pa a hy oid p ese a ion educe PH isk. Indi idualized
ea men p o ocols combining calcium and ac i e i amin D supplemen a ion imp o e pa ien
ou comes and minimize long- e m complica ions. Recombinan PTH analogs may be conside ed
in pe sis en cases.
Conclusion. Pos - hy oidec omy hypopa a hy oidism is equen and po en ially se ious.
Ea ly diagnosis using PTH and calcium moni o ing, ca e ul su gical echnique, and
indi idualized supplemen a ion s a egies op imize managemen , p e en acu e complica ions, and
imp o e quali y o li e. Fu u e s udies should ocus on s anda dized ea men algo i hms and
no el he apeu ic app oaches.
Re e ences:
1. Dughie o S., To esan F., Censi S., Mian C., Ca illo Liza azo J.L., Iacobone M. Risk and
P o ec i e Fac o s o Pos ope a i e and Pe sis en Hypopa a hy oidism a e To al
Thy oidec omy in a Se ies o 1965 Pa ien s // Cance s. — 2024. — Vol. 16, № 16. —
P. 2867. — DOI: 10.3390/cance s16162867.
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2. de Oli ei a R.A., S i pa o R.N., de Almeida M.Q., Pa eja B.P., Wagne A.J. P edic i e
ac o s o pe manen hypopa a hy oidism ollowing o al hy oidec omy: A e ospec i e
coho s udy o 5,671 cases // A chi es o Endoc inology and Me abolism. — 2024. —
Vol. 68. — A icle e240379. — DOI: 10.20945/2359-4292-2024-0379.
