Thoughts and suggestions on the definition of hypoparathyroidism after thyroidectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DONG Zhizhong ,  CHENG Ruochuan

Center for Diagnosis and Treatment of Thyroid Disease, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, P. R. China;

Corresponding author：

CHENG Ruochuan, Email: cruochuan@foxmail.com

Keywords：

thyroidectomy; hypothyroidism; definition

DOI：

10.7507/1007-9424.202410030

Video：

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Hypothyroidism is one of the focuses of attention in the field of thyroid surgery, but postoperative hypoparathyroidism has always been an unavoidable complication for surgeons. Currently, there is still controversy over the definition and classification of postoperative hypoparathyroidism, and there are significant differences in the definition and incidence of permanent hypoparathyroidism among different studies. The author provides preliminary suggestions and ideas for the diagnosis and definition of hypoparathyroidism based on relevant guidelines, literature, and clinical experience, in order to provide more accurate diagnosis and treatment plans for postoperative hypoparathyroidism.

1.	葛明华, 高明, 程若川. 中国肿瘤整合诊治指南. 甲状腺癌. 天津: 天津科学技术出版社, 2022: 1-138.
2.	Orloff LA, Wiseman SM, Bernet VJ, et al. American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults. Thyroid, 2018, 28(7): 830-841.
3.	Bollerslev J, Rejnmark L, Marcocci C, et al. European Society of Endocrinology Clinical Guideline: treatment of chronic hypoparathyroidism in adults. Eur J Endocrinol, 2015, 173(2): G1-20.
4.	Ning K, Yu Y, Zheng X, et al. Risk factors of transient and permanent hypoparathyroidism after thyroidectomy: a systematic review and meta-analysis. Int J Surg, 2024, 110(8): 5047-5062.
5.	Shoback DM, Bilezikian JP, Costa AG, et al. Presentation of hypoparathyroidism: etiologies and clinical features. J Clin Endocrinol Metab, 2016, 101(6): 2300-2312.
6.	Cusano NE, Bilezikian JP. Signs and symptoms of hypoparathyroidism. Endocrinol Metab Clin North Am, 2018, 47(4): 759-770.
7.	Cooper MS, Gittoes NJ. Diagnosis and management of hypocalcaemia. BMJ, 2008, 336(7656): 1298-1302.
8.	董治中, 刘文, 苏艳军, 等. 甲状腺全部切除术后甲状旁腺功能不全7例临床病例分析报告. 中国普外基础与临床杂志, 2022, 29(10): 1334-1338.
9.	Promberger R, Ott J, Kober F, et al. Normal parathyroid hormone levels do not exclude permanent hypoparathyroidism after thyroidectomy. Thyroid, 2011, 21(2): 145-150.
10.	Al-Khatib T, Althubaiti AM, Althubaiti A, et al. Severe vitamin D deficiency: a significant predictor of early hypocalcemia after total thyroidectomy. Otolaryngol Head Neck Surg, 2015, 152(3): 424-431.
11.	Bilezikian JP, Brandi ML, Cusano NE, et al. Management of hypoparathyroidism: present and future. J Clin Endocrinol Metab, 2016, 101(6): 2313-2324.
12.	Allgrove J, Adami S, Fraher L, et al. Hypomagnesaemia: studies of parathyroid hormone secretion and function. Clin Endocrinol (Oxf), 1984, 21(4): 435-449.
13.	Garrahy A, Murphy MS, Sheahan P. Impact of postoperative magnesium levels on early hypocalcemia and permanent hypoparathyroidism after thyroidectomy. Head Neck, 2016, 38(4): 613-619.
14.	中华医学会骨质疏松和骨矿盐疾病分会, 中华医学会内分泌分会代谢性骨病学组. 甲状旁腺功能减退症临床诊疗指南. 中华骨质疏松和骨矿盐疾病杂志, 2018, 11(4): 323-337.
15.	Brandi ML, Bilezikian JP, Shoback D, et al. Management of hypoparathyroidism: summary statement and guidelines. J Clin Endocrinol Metab, 2016, 101(6): 2273-2283.
16.	Khan AA, Bilezikian JP, Brandi ML, et al. Evaluation and management of hypoparathyroidism summary statement and guidelines from the Second International Workshop. J Bone Miner Res, 2022, 37(12): 2568-2585.
17.	Misiorowski W, Dedecjus M, Konstantynowicz J, et al. Management of hypoparathyroidism: a Position Statement of the Expert Group of the Polish Society of Endocrinology. Endokrynol Pol, 2023, 74(5): 447-467.
18.	Villarroya-Marquina I, Sancho J, Lorente-Poch L, et al. Time to parathyroid function recovery in patients with protracted hypoparathyroidism after total thyroidectomy. Eur J Endocrinol, 2018, 178(1): 103-111.
19.	Ritter K, Elfenbein D, Schneider DF, et al. Hypoparathyroidism after total thyroidectomy: incidence and resolution. J Surg Res, 2015, 197(2): 348-353.
20.	Kim SM, Kim HK, Kim KJ, et al. Recovery from permanent hypoparathyroidism after total thyroidectomy. Thyroid, 2015, 25(7): 830-833.
21.	郝军生. 甲状腺全切术后甲状旁腺功能减退的恢复时间分析 (附13例). 现代肿瘤医学, 2020, 28(11): 1867-1869.
22.	张萌萌. 生命、骨骼、维生素D3. 中国骨质疏松杂志, 2016, 22(11): 1496-1500.
23.	Holick MF. Vitamin D deficiency. N Engl J Med, 2007, 357(3): 266-281.
24.	Unsal IO, Calapkulu M, Sencar ME, et al. Preoperative vitamin D levels as a predictor of transient hypocalcemia and hypoparathyroidism after parathyroidectomy. Sci Rep, 2020, 10(1): 9895.
25.	Casey C, Hopkins D. The role of preoperative vitamin D and calcium in preventing post-thyroidectomy hypocalcaemia: a systematic review. Eur Arch Otorhinolaryngol, 2023, 280(4): 1555-1563.
26.	中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 2015, 35(7): 731-736.
27.	陈会彬. 甲状腺全切术后预防性补钙的临床研究. 昆明医学院, 2011.
28.	艾杨卿. 甲状腺术中甲状旁腺的功能保护及术后预防性补钙对患者影响的临床研究. 昆明医学院, 2009.
29.	程若川, 刘文. 中国甲状腺癌术后随访和临床研究现状反思. 中国普通外科杂志, 2017, 26(11): 1375-1382.
30.	程若川, 刘文. 厚积薄发——中国甲状腺肿瘤临床数据库分级质量管理的建议与思考. 中国普通外科杂志, 2020, 29(11): 1285-1292.
31.	Harsløf T, Rolighed L, Rejnmark L. Huge variations in definition and reported incidence of postsurgical hypoparathyroidism: a systematic review. Endocrine, 2019, 64(1): 176-183.

1. 葛明华, 高明, 程若川. 中国肿瘤整合诊治指南. 甲状腺癌. 天津: 天津科学技术出版社, 2022: 1-138.
2. Orloff LA, Wiseman SM, Bernet VJ, et al. American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults. Thyroid, 2018, 28(7): 830-841.
3. Bollerslev J, Rejnmark L, Marcocci C, et al. European Society of Endocrinology Clinical Guideline: treatment of chronic hypoparathyroidism in adults. Eur J Endocrinol, 2015, 173(2): G1-20.
4. Ning K, Yu Y, Zheng X, et al. Risk factors of transient and permanent hypoparathyroidism after thyroidectomy: a systematic review and meta-analysis. Int J Surg, 2024, 110(8): 5047-5062.
5. Shoback DM, Bilezikian JP, Costa AG, et al. Presentation of hypoparathyroidism: etiologies and clinical features. J Clin Endocrinol Metab, 2016, 101(6): 2300-2312.
6. Cusano NE, Bilezikian JP. Signs and symptoms of hypoparathyroidism. Endocrinol Metab Clin North Am, 2018, 47(4): 759-770.
7. Cooper MS, Gittoes NJ. Diagnosis and management of hypocalcaemia. BMJ, 2008, 336(7656): 1298-1302.
8. 董治中, 刘文, 苏艳军, 等. 甲状腺全部切除术后甲状旁腺功能不全7例临床病例分析报告. 中国普外基础与临床杂志, 2022, 29(10): 1334-1338.
9. Promberger R, Ott J, Kober F, et al. Normal parathyroid hormone levels do not exclude permanent hypoparathyroidism after thyroidectomy. Thyroid, 2011, 21(2): 145-150.
10. Al-Khatib T, Althubaiti AM, Althubaiti A, et al. Severe vitamin D deficiency: a significant predictor of early hypocalcemia after total thyroidectomy. Otolaryngol Head Neck Surg, 2015, 152(3): 424-431.
11. Bilezikian JP, Brandi ML, Cusano NE, et al. Management of hypoparathyroidism: present and future. J Clin Endocrinol Metab, 2016, 101(6): 2313-2324.
12. Allgrove J, Adami S, Fraher L, et al. Hypomagnesaemia: studies of parathyroid hormone secretion and function. Clin Endocrinol (Oxf), 1984, 21(4): 435-449.
13. Garrahy A, Murphy MS, Sheahan P. Impact of postoperative magnesium levels on early hypocalcemia and permanent hypoparathyroidism after thyroidectomy. Head Neck, 2016, 38(4): 613-619.
14. 中华医学会骨质疏松和骨矿盐疾病分会, 中华医学会内分泌分会代谢性骨病学组. 甲状旁腺功能减退症临床诊疗指南. 中华骨质疏松和骨矿盐疾病杂志, 2018, 11(4): 323-337.
15. Brandi ML, Bilezikian JP, Shoback D, et al. Management of hypoparathyroidism: summary statement and guidelines. J Clin Endocrinol Metab, 2016, 101(6): 2273-2283.
16. Khan AA, Bilezikian JP, Brandi ML, et al. Evaluation and management of hypoparathyroidism summary statement and guidelines from the Second International Workshop. J Bone Miner Res, 2022, 37(12): 2568-2585.
17. Misiorowski W, Dedecjus M, Konstantynowicz J, et al. Management of hypoparathyroidism: a Position Statement of the Expert Group of the Polish Society of Endocrinology. Endokrynol Pol, 2023, 74(5): 447-467.
18. Villarroya-Marquina I, Sancho J, Lorente-Poch L, et al. Time to parathyroid function recovery in patients with protracted hypoparathyroidism after total thyroidectomy. Eur J Endocrinol, 2018, 178(1): 103-111.
19. Ritter K, Elfenbein D, Schneider DF, et al. Hypoparathyroidism after total thyroidectomy: incidence and resolution. J Surg Res, 2015, 197(2): 348-353.
20. Kim SM, Kim HK, Kim KJ, et al. Recovery from permanent hypoparathyroidism after total thyroidectomy. Thyroid, 2015, 25(7): 830-833.
21. 郝军生. 甲状腺全切术后甲状旁腺功能减退的恢复时间分析 (附13例). 现代肿瘤医学, 2020, 28(11): 1867-1869.
22. 张萌萌. 生命、骨骼、维生素D3. 中国骨质疏松杂志, 2016, 22(11): 1496-1500.
23. Holick MF. Vitamin D deficiency. N Engl J Med, 2007, 357(3): 266-281.
24. Unsal IO, Calapkulu M, Sencar ME, et al. Preoperative vitamin D levels as a predictor of transient hypocalcemia and hypoparathyroidism after parathyroidectomy. Sci Rep, 2020, 10(1): 9895.
25. Casey C, Hopkins D. The role of preoperative vitamin D and calcium in preventing post-thyroidectomy hypocalcaemia: a systematic review. Eur Arch Otorhinolaryngol, 2023, 280(4): 1555-1563.
26. 中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 2015, 35(7): 731-736.
27. 陈会彬. 甲状腺全切术后预防性补钙的临床研究. 昆明医学院, 2011.
28. 艾杨卿. 甲状腺术中甲状旁腺的功能保护及术后预防性补钙对患者影响的临床研究. 昆明医学院, 2009.
29. 程若川, 刘文. 中国甲状腺癌术后随访和临床研究现状反思. 中国普通外科杂志, 2017, 26(11): 1375-1382.
30. 程若川, 刘文. 厚积薄发——中国甲状腺肿瘤临床数据库分级质量管理的建议与思考. 中国普通外科杂志, 2020, 29(11): 1285-1292.
31. Harsløf T, Rolighed L, Rejnmark L. Huge variations in definition and reported incidence of postsurgical hypoparathyroidism: a systematic review. Endocrine, 2019, 64(1): 176-183.

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