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Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy

Postoperative parathyroid failure is the commonest adverse effect of total thyroidectomy, which is a widely used surgical procedure to treat both benign and malignant thyroid disorders. The present review focuses on the scientific gap and lack of data regarding the time period elapsed between the im...

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Autor principal: Sitges-Serra, Antonio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867256/
https://www.ncbi.nlm.nih.gov/pubmed/33540657
http://dx.doi.org/10.3390/jcm10030543
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author Sitges-Serra, Antonio
author_facet Sitges-Serra, Antonio
author_sort Sitges-Serra, Antonio
collection PubMed
description Postoperative parathyroid failure is the commonest adverse effect of total thyroidectomy, which is a widely used surgical procedure to treat both benign and malignant thyroid disorders. The present review focuses on the scientific gap and lack of data regarding the time period elapsed between the immediate postoperative period, when hypocalcemia is usually detected by the surgeon, and permanent hypoparathyroidism often seen by an endocrinologist months or years later. Parathyroid failure after thyroidectomy results from a combination of trauma, devascularization, inadvertent resection, and/or autotransplantation, all resulting in an early drop of iPTH (intact parathyroid hormone) requiring replacement therapy with calcium and calcitriol. There is very little or no role for other factors such as vitamin D deficiency, calcitonin, or magnesium. Recovery of the parathyroid function is a dynamic process evolving over months and cannot be predicted on the basis of early serum calcium and iPTH measurements; it depends on the number of parathyroid glands remaining in situ (PGRIS)—not autotransplanted nor inadvertently excised—and on early administration of full-dose replacement therapy to avoid hypocalcemia during the first days/weeks after thyroidectomy.
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spelling pubmed-78672562021-02-07 Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy Sitges-Serra, Antonio J Clin Med Review Postoperative parathyroid failure is the commonest adverse effect of total thyroidectomy, which is a widely used surgical procedure to treat both benign and malignant thyroid disorders. The present review focuses on the scientific gap and lack of data regarding the time period elapsed between the immediate postoperative period, when hypocalcemia is usually detected by the surgeon, and permanent hypoparathyroidism often seen by an endocrinologist months or years later. Parathyroid failure after thyroidectomy results from a combination of trauma, devascularization, inadvertent resection, and/or autotransplantation, all resulting in an early drop of iPTH (intact parathyroid hormone) requiring replacement therapy with calcium and calcitriol. There is very little or no role for other factors such as vitamin D deficiency, calcitonin, or magnesium. Recovery of the parathyroid function is a dynamic process evolving over months and cannot be predicted on the basis of early serum calcium and iPTH measurements; it depends on the number of parathyroid glands remaining in situ (PGRIS)—not autotransplanted nor inadvertently excised—and on early administration of full-dose replacement therapy to avoid hypocalcemia during the first days/weeks after thyroidectomy. MDPI 2021-02-02 /pmc/articles/PMC7867256/ /pubmed/33540657 http://dx.doi.org/10.3390/jcm10030543 Text en © 2021 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Sitges-Serra, Antonio
Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy
title Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy
title_full Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy
title_fullStr Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy
title_full_unstemmed Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy
title_short Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy
title_sort etiology and diagnosis of permanent hypoparathyroidism after total thyroidectomy
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867256/
https://www.ncbi.nlm.nih.gov/pubmed/33540657
http://dx.doi.org/10.3390/jcm10030543
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