{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T19:34:57Z","timestamp":1792697697854,"version":"4.5.0"},"reference-count":35,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T00:00:00Z","timestamp":1675209600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Thyroid\u00ae"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Total thyroidectomy for Graves' disease (GD) is associated with rapid treatment of hyperthyroidism and low recurrence rates. However, it carries the risk of surgical complications including permanent hypoparathyroidism, which contributes to long-term impaired quality of life. The objective of this study was to determine the incidence of permanent hypoparathyroidism requiring calcitriol therapy among a population-based cohort of older adults undergoing total thyroidectomy for GD in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We performed a population-based cohort study using 100% Medicare claims from beneficiaries older than 65 years with GD who underwent total thyroidectomy from 2007 to 2017. We required continuous enrollment in Medicare Parts A, B, and D for 12 months before and after surgery to ensure access to comprehensive claims data. Patients were excluded if they had a preoperative diagnosis of thyroid cancer or were on long-term preoperative calcitriol. Our primary outcome was permanent hypoparathyroidism, which was identified based on persistent use of calcitriol between 6 and 12 months following thyroidectomy. We used multivariable logistic regression to identify characteristics associated with permanent hypoparathyroidism, including patient age, sex, race\/ethnicity, neighborhood disadvantage, Charlson\u2013Deyo Comorbidity Index, urban or rural residence, and frailty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      We identified 4650 patients who underwent total thyroidectomy for GD during the study period and met the inclusion criteria (mean age\u2009=\u200972.8 years [standard deviation\u2009=\u20095.5], 86% female, and 79% white). Among this surgical cohort, 104 (2.2% [95% confidence interval, CI\u2009=\u20091.8\u20132.7%]) patients developed permanent hypoparathyroidism requiring calcitriol therapy. Patients who developed permanent hypoparathyroidism were on average older (mean age 74.1 vs. 72.8 years) than those who did not develop permanent hypoparathyroidism (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.04). On multivariable regression, older age was the only patient characteristic associated with permanent hypoparathyroidism (odds ratio age \u226576 years\u2009=\u20091.68 [CI\u2009=\u20091.13\u20132.51] compared with age 66\u201375 years).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The risk of permanent hypoparathyroidism requiring calcitriol therapy among this national, U.S. population-based cohort of older adults with GD treated with total thyroidectomy was low, even when considering operations performed by a heterogeneous group of surgeons. These findings suggest that the risk of hypoparathyroidism should not be a deterrent to operative management for GD in older adults who are appropriate surgical candidates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/thy.2022.0140","type":"journal-article","created":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T05:53:15Z","timestamp":1669182795000},"page":"223-229","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Risk of Permanent Hypoparathyroidism Requiring Calcitriol Therapy in a Population-Based Cohort of Adults Older Than 65 Undergoing Total Thyroidectomy for Graves' Disease"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2438-9658","authenticated-orcid":false,"given":"Carolyn Dacey","family":"Seib","sequence":"first","affiliation":[{"name":"Stanford\u2013Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA."},{"name":"Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA."},{"name":"Division of General Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Meng","sequence":"additional","affiliation":[{"name":"Stanford\u2013Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA."},{"name":"Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin M.","family":"Cisco","sequence":"additional","affiliation":[{"name":"Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana T.","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"McAninch","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Palo Alto, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Palo Alto, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjula Kurella","family":"Tamura","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education and Clinical Center, Veterans Affairs Palo Alto, Palo Alto, California, USA."},{"name":"Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber W.","family":"Trickey","sequence":"additional","affiliation":[{"name":"Stanford\u2013Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5254-1456","authenticated-orcid":false,"given":"Electron","family":"Kebebew","sequence":"additional","affiliation":[{"name":"Department of Surgery, Stanford University School of Medicine, Palo Alto, California, 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