{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T20:37:17Z","timestamp":1789763837139,"version":"4.0.1"},"reference-count":30,"publisher":"Bioscientifica","issue":"9","license":[{"start":{"date-parts":[[2023,7,24]],"date-time":"2023-07-24T00:00:00Z","timestamp":1690156800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["ec.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,7,24]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Total thyroidectomy is associated with a high risk of postoperative hypoparathyroidism, mainly due to the unintended surgical damage to the parathyroid glands or their blood supply. It is possible that surgeons who also perform parathyroid surgery see lower rates of postoperative hypoparathyroidism. In a single institution, we investigated the effects of restricting total thyroidectomy operations for Graves\u2019 disease to two surgeons who performed both thyroid and parathyroid surgeries. We aimed to evaluate the rates of postoperative hypoparathyroidism in a 10-year period with primary attention toward patients with Graves\u2019 disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study from a single institution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We defined the rate of permanent hypoparathyroidism after total thyroidectomy as the need for active vitamin D 6 months postoperatively. Between 2012 and 2016, seven surgeons performed all thyroidectomies. From January 2017, only surgeons also performing parathyroid surgery carried out thyroidectomies for Graves\u2019 disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We performed total thyroidectomy in 543 patients. The rate of permanent hypoparathyroidism decreased from 28% in 2012\u20132014 to 6% in 2020\u20132021. For patients with Graves\u2019 disease, the rate of permanent hypoparathyroidism decreased from 36% (13 out of 36) in 2015\u20132016 to 2% (1 out of 56) in 2020\u20132021. In cancer patients, the rate of permanent hypoparathyroidism decreased from 30% (14 out of 46) in 2012\u20132014 to 10% (10 out of 51) in 2020\u20132021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Restricting thyroidectomy to surgeons who also performed parathyroid operations reduced postoperative hypoparathyroidism markedly. Accordingly, we recommend centralisation of the most difficult thyroid operations to centres and surgeons with extensive experience in parathyroid surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance statement<\/jats:title>\n                    <jats:p>Thyroid surgery is performed by many different surgeons with marked differences in outcome. Indeed, the risk of postoperative permanent hypoparathyroidism may be very high in low-volume centres. This serious condition affects the quality of life and increases long-term morbidity and the patients develop a life-long dependency of medical treatments. We encountered a high risk of hypoparathyroidism after the operation for Graves\u2019 disease and restricted the number of surgeons to two for these operations. Further, these surgeons were experienced in both thyroid and parathyroid surgeries. We show a dramatic reduction in postoperative hypoparathyroidism after this change. Accordingly, we recommend centralisation of total thyroidectomy to surgeons with experience in both thyroid and parathyroid procedures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/ec-23-0198","type":"journal-article","created":{"date-parts":[[2023,7,24]],"date-time":"2023-07-24T14:32:13Z","timestamp":1690209133000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-10","source":"Crossref","is-referenced-by-count":8,"title":["Total thyroidectomy: reduction in postoperative hypoparathyroidism"],"prefix":"10.1530","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6672-2714","authenticated-orcid":true,"given":"Rasmus","family":"Reinke","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4772-6848","authenticated-orcid":true,"given":"Stefano Christian","family":"Londero","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0953-1188","authenticated-orcid":true,"given":"Martin","family":"Almquist","sequence":"additional","affiliation":[{"name":"Department of Surgery, Lund University Hospital, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2152-4247","authenticated-orcid":true,"given":"Lars","family":"Rejnmark","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0757-298X","authenticated-orcid":true,"given":"Lars","family":"Rolighed","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Danish Medical Journal","first-page":"A5157","article-title":"Post-operative parathyroid hormone can be used as a predictor of normocalcaemia after total thyroidectomy","volume":"62","author":"Abdel-Halim","year":"2015","unstructured":"Abdel-Halim CNRejnmark L & Nielsen VE. Post-operative parathyroid hormone can be used as a predictor of normocalcaemia after total thyroidectomy. Danish Medical Journal201562A5157."},{"key":"bib2","series-title":"Danish Medical Journal","first-page":"A11190647","article-title":"High incidence of chronic hypoparathyroidism secondary to total thyroidectomy","volume":"67","author":"Jorgensen","year":"2020","unstructured":"Jorgensen CUHomoe PDahl M & Hitz MF. High incidence of chronic hypoparathyroidism secondary to total thyroidectomy. Danish Medical Journal202067A11190647."},{"key":"bib3","series-title":"New England Journal of Medicine","first-page":"1863","article-title":"Hyperparathyroid and hypoparathyroid disorders","volume":"343","author":"Marx","year":"2000","unstructured":"Marx SJ. Hyperparathyroid and hypoparathyroid disorders. New England Journal of Medicine20003431863\u20131875. (https:\/\/doi.org\/10.1056\/NEJM200012213432508)"},{"key":"bib4","series-title":"Journal of Bone and Mineral Research","first-page":"1440","article-title":"Concurrent hypoparathyroidism is associated with impaired physical function and quality of life in hypothyroidism","volume":"31","author":"Sikjaer","year":"2016","unstructured":"Sikjaer TMoser ERolighed LUnderbjerg LBislev LSMosekilde L & Rejnmark L. Concurrent hypoparathyroidism is associated with impaired physical function and quality of life in hypothyroidism. Journal of Bone and Mineral Research2016311440\u20131448. (https:\/\/doi.org\/10.1002\/jbmr.2812)"},{"key":"bib5","series-title":"British Journal of Surgery","first-page":"1313","article-title":"Mortality in patients with permanent hypoparathyroidism after total thyroidectomy","volume":"105","author":"Almquist","year":"2018","unstructured":"Almquist MIvarsson KNordenstrom E & Bergenfelz A. Mortality in patients with permanent hypoparathyroidism after total thyroidectomy. British Journal of Surgery20181051313\u20131318. (https:\/\/doi.org\/10.1002\/bjs.10843)"},{"key":"bib6","series-title":"Surgery","first-page":"124","article-title":"Morbidity in patients with permanent hypoparathyroidism after total thyroidectomy","volume":"167","author":"Bergenfelz","year":"2020","unstructured":"Bergenfelz ANordenstrom E & Almquist M. Morbidity in patients with permanent hypoparathyroidism after total thyroidectomy. Surgery2020167124\u2013128. (https:\/\/doi.org\/10.1016\/j.surg.2019.06.056)"},{"key":"bib7","series-title":"Journal of Clinical Endocrinology and Metabolism","first-page":"e4098","article-title":"Kidney complications and hospitalization in patients with chronic hypoparathyroidism: a cohort study in Sweden","volume":"107","author":"Swartling","year":"2022","unstructured":"Swartling OEvans MSpelman TKamal WKampe OMannstadt MTrolle Lagerros Y & Bjornsdottir S. 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Endocrine201964176\u2013183. (https:\/\/doi.org\/10.1007\/s12020-019-01858-4)"},{"key":"bib10","series-title":"JAMA Otolaryngology\u2013 Head and Neck Surgery","first-page":"959","article-title":"Persistent postthyroidectomy hypoparathyroidism in the Netherlands","volume":"147","author":"Loncar","year":"2021","unstructured":"Loncar INoltes MEDickhoff CEngelsman AFSchepers AVriens MRBouvy NDKruijff S & van Ginhoven TM. Persistent postthyroidectomy hypoparathyroidism in the Netherlands. JAMA Otolaryngology\u2013 Head and Neck Surgery2021147959\u2013965. (https:\/\/doi.org\/10.1001\/jamaoto.2021.2475)"},{"key":"bib11","series-title":"Annals of Surgery","first-page":"e1202","article-title":"Risk of permanent hypoparathyroidism after total thyroidectomy for benign disease: a nationwide population-based cohort study from Sweden","volume":"274","author":"Anneback","year":"2021","unstructured":"Anneback MHedberg JAlmquist MStalberg P & Norlen O. Risk of permanent hypoparathyroidism after total thyroidectomy for benign disease: a nationwide population-based cohort study from Sweden. Annals of Surgery2021274e1202\u2013e1208. (https:\/\/doi.org\/10.1097\/SLA.0000000000003800)"},{"key":"bib12","series-title":"Sisli Etfal Hastanesi Tip Bulteni","first-page":"262","article-title":"The reality of hypoparathyroidism after thyroidectomy: which risk factors are effective? Single-center study","volume":"56","author":"Akgun","year":"2022","unstructured":"Akgun IEUnlu MTAygun NKostek MTufan AEYanar CYuksel ABaran ECakir Y & Uludag M. The reality of hypoparathyroidism after thyroidectomy: which risk factors are effective? Single-center study. Sisli Etfal Hastanesi Tip Bulteni202256262\u2013269. (https:\/\/doi.org\/10.14744\/SEMB.2022.24356)"},{"key":"bib13","series-title":"Endocrine","first-page":"151","article-title":"Actual prevalence of hypoparathyroidism after total thyroidectomy: a health insurance claims-database study","volume":"78","author":"Takahashi","year":"2022","unstructured":"Takahashi TYamazaki KShodo RUeki Y & Horii A. Actual prevalence of hypoparathyroidism after total thyroidectomy: a health insurance claims-database study. Endocrine202278151\u2013158. (https:\/\/doi.org\/10.1007\/s12020-022-03153-1)"},{"key":"bib14","series-title":"European Journal of Endocrinology","first-page":"R33","article-title":"European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE educational program of parathyroid disorders","volume":"186","author":"Bollerslev","year":"2022","unstructured":"Bollerslev JRejnmark LZahn AHeck AAppelman-Dijkstra NMCardoso LHannan FMCetani FSikj\u00e6r TFormenti AM, European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE educational program of parathyroid disorders. European Journal of Endocrinology2022186R33\u2013R63. (https:\/\/doi.org\/10.1530\/EJE-21-1044)"},{"key":"bib15","series-title":"Gland Surgery","first-page":"3007","article-title":"Effect of postsurgical chronic hypoparathyroidism on morbidity and mortality: a systematic review and meta-analysis","volume":"10","author":"Hadedeya","year":"2021","unstructured":"Hadedeya DKay JAttia AOmar MShalaby MYoussef MRShama MToraih E & Kandil E. Effect of postsurgical chronic hypoparathyroidism on morbidity and mortality: a systematic review and meta-analysis. Gland Surgery2021103007\u20133019. (https:\/\/doi.org\/10.21037\/gs-21-181)"},{"key":"bib16","series-title":"Journal of Clinical Endocrinology and Metabolism","first-page":"4507","article-title":"Long-term follow-up of patients with hypoparathyroidism","volume":"97","author":"Mitchell","year":"2012","unstructured":"Mitchell DMRegan SCooley MRLauter KBVrla MCBecker CBBurnett-Bowie SA & Mannstadt M. Long-term follow-up of patients with hypoparathyroidism. Journal of Clinical Endocrinology and Metabolism2012974507\u20134514. (https:\/\/doi.org\/10.1210\/jc.2012-1808)"},{"key":"bib17","series-title":"Advances in Therapy","first-page":"1946","article-title":"Risk of nephrolithiasis and nephrocalcinosis in patients with chronic hypoparathyroidism: a retrospective cohort study","volume":"38","author":"Ketteler","year":"2021","unstructured":"Ketteler MChen KGosmanova EOSignorovitch JMu FYoung JASherry N & Rejnmark L. Risk of nephrolithiasis and nephrocalcinosis in patients with chronic hypoparathyroidism: a retrospective cohort study. Advances in Therapy2021381946\u20131957. (https:\/\/doi.org\/10.1007\/s12325-021-01649-2)"},{"key":"bib18","series-title":"Thyroid","first-page":"830","article-title":"American Thyroid Association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults","volume":"28","author":"Orloff","year":"2018","unstructured":"Orloff LAWiseman SMBernet VJFahey TJShaha ARShindo MLSnyder SKStack BCSunwoo JB & Wang MB. American Thyroid Association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid201828830\u2013841. (https:\/\/doi.org\/10.1089\/thy.2017.0309)"},{"key":"bib19","series-title":"Journal of Bone and Mineral Research","first-page":"2277","article-title":"Cardiovascular and renal complications to postsurgical hypoparathyroidism: a Danish nationwide controlled historic follow-up study","volume":"28","author":"Underbjerg","year":"2013","unstructured":"Underbjerg LSikjaer TMosekilde L & Rejnmark L. Cardiovascular and renal complications to postsurgical hypoparathyroidism: a Danish nationwide controlled historic follow-up study. Journal of Bone and Mineral Research2013282277\u20132285. (https:\/\/doi.org\/10.1002\/jbmr.1979)"},{"key":"bib20","series-title":"Journal of Laryngology and Otology","first-page":"568","article-title":"Use of pre-operative calcium and vitamin D supplementation to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy: a systematic review","volume":"135","author":"Khatiwada","year":"2021","unstructured":"Khatiwada AS & Harris AS. Use of pre-operative calcium and vitamin D supplementation to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy: a systematic review. Journal of Laryngology and Otology2021135568\u2013573. (https:\/\/doi.org\/10.1017\/S0022215121001523)"},{"key":"bib21","series-title":"Journal of Clinical Medicine","article-title":"Post-operative permanent hypoparathyroidism and preoperative vitamin D prophylaxis","volume":"10","author":"Kannan","year":"2021","unstructured":"Kannan TFoster YHo DJGelzinnis SJMerakis MBalogh ZJWynne K & Bendinelli C. Post-operative permanent hypoparathyroidism and preoperative vitamin D prophylaxis. Journal of Clinical Medicine202110. (https:\/\/doi.org\/10.3390\/jcm10030442)"},{"key":"bib22","series-title":"Journal of Laryngology and Otology","first-page":"925","article-title":"Impact of pre-operative serum 25-hydroxyvitamin D on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre: retrospective study of 246 patients","volume":"131","author":"Erlem","year":"2017","unstructured":"Erlem MKlopp-Dutote NBiet-Hornstein AStrunski V & Page C. 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(https:\/\/doi.org\/10.21037\/gs.2017.09.03)"},{"key":"bib24","series-title":"Thyroid","first-page":"1","article-title":"2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer","volume":"26","author":"Haugen","year":"2016","unstructured":"Haugen BRAlexander EKBible KCDoherty GMMandel SJNikiforov YEPacini FRandolph GWSawka AMSchlumberger M, 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid2016261\u2013133. (https:\/\/doi.org\/10.1089\/thy.2015.0020)"},{"key":"bib25","series-title":"Surgery","first-page":"193","article-title":"Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection","volume":"159","author":"McWade","year":"2016","unstructured":"McWade MASanders MEBroome JTSolorzano CC & Mahadevan-Jansen A. Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection. Surgery2016159193\u2013202. (https:\/\/doi.org\/10.1016\/j.surg.2015.06.047)"},{"key":"bib26","series-title":"Surgery","first-page":"23","article-title":"Impact of autofluorescence-based identification of parathyroids during total thyroidectomy on postoperative hypocalcemia: a before and after controlled study","volume":"163","author":"Benmiloud","year":"2018","unstructured":"Benmiloud FRebaudet SVaroquaux APenaranda GBannier M & Denizot A. 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