BACKGROUND
Thyroid surgery is indicated to treat a variety of conditions, including thyroid cancer, thyroid nodules and an overactive thyroid (hyperthyroidism). One potential complication of thyroid surgery is damage to the parathyroid glands, which are located next to the thyroid. The parathyroid glands control the body’s calcium levels and there are usually 4 – 2 on each side of the thyroid. Damage to the parathyroid glands can cause hypoparathyroidism which causes low calcium levels. Low calcium levels may be associated with muscle twitching or cramping and, if severe, can cause seizures and/or heart problems. During thyroid surgery, the parathyroid glands may be damaged as a result of losing their blood supply or being removed completely as part of the operation. At least 1 ½ of the parathyroid glands are needed to maintain normal calcium levels. Because of this, hypoparathyroidism is a possible complication of a total thyroidectomy, not a lobectomy. Hypoparathyroidism represents more than half of the complications of thyroidectomy, with rates ranging from 15 to 30% for short-lived hypoparathyroidism after surgery and from 1 to 7% for permanent hypoparathyroidism. Treatment for hypoparathyroidism includes calcium and vitamin D supplements to manage this condition.

This study aimed to assess the symptoms and quality of life (QoL) of patients with hypoparathyroidism after undergoing thyroid surgery and to compare them with those with normal parathyroid function after surgery.

THE FULL ARTICLE TITLE
Hillary SL et al 2022 Quality of life in post-surgical hypoparathyroidism (PoSH) in thyroid and parathyroid surgery. World J Surg 46:3025–3033. PMID: 36184675.

SUMMARY OF THE STUDY
Patients who underwent thyroid surgery (total thyroidectomy) were studied. The records of 875 patients with a history of total thyroidectomy or bilateral neck exploration were reviewed; 16 of these patients had permanent postoperative hypoparathyroidism (requiring treatment of more than 6 months’ duration). Those patients were matched with patients with normal parathyroid function after surgery by sex, age, and procedure in the same year, resulting in a subgroup of 48 patients. The study was conducting using an Internet based questionnaire/survey about patient’s symptoms and quality of life.

There were 439 survey respondents who were classified according to presence or absence of postoperative hypoparathyroidism. Most (86%) were female, and the average age was 52 years. The years of surgery ranged from 1973 to 2019, and 347 respondents fully completed the questionnaire. The average QoL score in those with postoperative hypoparathyroidism was significantly lower than in those without (54.2% vs. 60.6%), The main cause of this difference was that patients with hypoparathyroidism reported significantly lower levels of energy after the procedure. Of the 88 patients with available serum calcium levels, only 43% reported them to be in the normal range but there was no difference in QoL scores related to calcium levels. Finally, of the 11 patients who self-identified as having postoperative hypoparathyroidism, all had been prescribed vitamin D.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
Hypoparathyroidism is a complication of thyroid surgery. It may impact patients in the short-term or long-term following the surgery, especially in terms of fatigue and energy levels. This study helps us better understand the impact on the quality of life of patients who have undergone this procedure. Further understanding of this condition and developing more effective treatment options are necessary.

— Vibhavasu Sharma, MD, F.A.C.E

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