Hypoparathyroidism After Total Thyroidectomy: Importance of the Intraoperative Management of the Parathyroid Glands

  • Guillermo Ponce de León-Ballesteros
  • David Velázquez-Fernández
  • F. Javier Hernández-Calderón
  • Carlos Bonilla-Ramírez
  • Rafael H. Pérez-Soto
  • Juan Pablo Pantoja
  • Mauricio Sierra
  • Miguel F. HerreraEmail author
Original Scientific Report



Total thyroidectomy is the most common surgical procedure for the treatment of thyroid diseases. Postoperative hypocalcemia/hypoparathyroidism is the most frequent complication after total thyroidectomy. The aim of this study was to evaluate the rate of postoperative hypocalcemia and permanent hypoparathyroidism after total thyroidectomy in order to identify potential risk factors and to evaluate the impact of parathyroid autotransplantation.

Patients and Methods

We performed a retrospective analysis of 1018 patients who underwent total thyroidectomy at our institution between 2000 and 2016. Medical records were reviewed to analyze patient features, clinical presentation, management and postoperative complications. Descriptive and inferential statistics were employed based on the natural scaling of each included variable. Statistical significance was set at p ≤ 0.05.


Mean ± SD age was 46.79 ± 15.9 years; 112 (11.7%) were males and 844 (88.3%) females. A total of 642 (67.2%) patients underwent surgery for malignant disease. The rate of postoperative hypocalcemia, transient, protracted and permanent hypoparathyroidism was 32.8%, 14.43%, 18.4% and 3.9%, respectively. Permanent hypoparathyroidism was significantly associated with the number of parathyroid glands remaining in situ (4 glands: 2.5%, 3 glands: 3.8%, 1–2 glands: 13.3%; p ˂ 0.0001) [OR for 1–2 glands in situ = 5.32, CI 95% 2.61–10.82]. Other risk factors related to permanent hypoparathyroidism were obesity (OR 3.56, CI 95% 1.79–7.07), concomitant level VI lymph node dissection (OR 3.04, CI 95% 1.46–6.37) and incidental parathyroidectomy without autotransplantation (OR 3.6, CI 95% 1.85–7.02).


Identification and in situ preservation of at least three parathyroid glands were associated with a lower rate of postoperative hypocalcemia (30.4%) and permanent postoperative hypoparathyroidism (2.79%).



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Copyright information

© Société Internationale de Chirurgie 2019
corrected publication 2019

Authors and Affiliations

  • Guillermo Ponce de León-Ballesteros
    • 1
  • David Velázquez-Fernández
    • 1
  • F. Javier Hernández-Calderón
    • 1
  • Carlos Bonilla-Ramírez
    • 1
  • Rafael H. Pérez-Soto
    • 1
  • Juan Pablo Pantoja
    • 1
  • Mauricio Sierra
    • 1
  • Miguel F. Herrera
    • 1
    Email author
  1. 1.Service of Endocrine and Advanced Laparoscopic Surgery/Department of SurgeryInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiranMexico CityMexico

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