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Program Number: AHNS29
Session Name: Scientific Session 6 - Endocrine
Session Date: Thursday, May 15, 2025
Session Time: 1:00 PM - 1:45 PM

Hypoparathyroidism After Total Thyroidectomy: A Quality of Life Randomized Controlled Trial Comparing Two Treatment Strategies

Catherine Beaumont, MD, MSc¹; Francis Gilbert, MD, FRCSC²; Rémy-Thomas Couture, MD³; Nathalie Audet, MD, FRCSC¹; Danielle Beaudoin, MD, FRCSC¹; Jean-Philippe Vézina, MD, FRCSC¹; ¹CHU de Québec - Université Laval, ENT-H&N Surgery Department; ²CISSS de Chaudière-Appalaches and Université Laval, ENT-H&N Surgery Department; ³Centre hospitalier universitaire de Sherbrooke, ENT-H&N Surgery Department

Transient hypoparathyroidism and hypocalcemia are complications from total thyroidectomy (TT). One way to prevent hypocalcemia after TT is to give calcium and calcitriol supplementation to every patient. Another way is to treat depending on post-operative parathormone (PTH) levels. Both technics are approved by the American Endocrine Society. Iatrogenic hypo or hypercalcemia can impact the patient’s quality of life. The objective of our study is to compare the quality of life of patients receiving empirical calcium and calcitriol supplementation versus a PTH-guided treatment. 

We conducted a monocentric randomized-controlled trial. We included patients over 18-year-old undergoing TT or completion thyroidectomy, without central or lateral neck dissection. Group 1 was treated according to a PTH ratio; if the post-operative to pre-operative PTH ratio was of 25% or less, the patient was prescribed calcium carbonate and calcitriol (Figure 1). No treatment was given to patients with a ratio over 25%. In Group 2, all patients were given the same calcium and calcitriol dosage, regardless of the PTH ratio. Patients were asked to fill the 36-Item Short Form Health Survey (SF-36) before surgery, at one week and at one month. A second questionnaire investigating treatment adhesion and symptoms of hypo or hypercalcemia was completed at one week and one month.  

A total of 77 patients were randomized, 34 in Group 1 and 43 in Group 2. Parametric and nonparametric tests were used for statistical analysis. The alpha error was set at 0.05. The groups were similar in sex, age, surgery type, parathyroid reimplantation and pre-operative PTH, calcium and vitamin D levels. 

In Group 1, 14 patients received calcium and calcitriol, and 20 patients did not receive any supplements. In Group 2, 33% of patients developed hypercalcemia at one week which led to treatment interruption, compared to 9% of patients in Group 1. Interestingly, two patients in Group 1 were hospitalized for symptomatic hypocalcemia and IV treatment. Both had a PTH measure below 15, which is the minimal normal PTH threshold. Symptomatic hypercalcemia requiring hospitalization and IV hydration developed in two patients in Group 2.

Emotional well-being score was significantly better in Group 1 than in Group 2 one month after the surgery (p = 0.02). Patients in Group 2 had significantly more constipation at one week and one month (p = 0.0006 and p = 0.01, respectively). No other significant difference in quality of life or calcium-related symptoms were present. 

In conclusion, the quality of life of patients after thyroid surgery is similar with both strategies to prevent hypocalcemia. Using a PTH ratio would save medication intake to more than half of the patients and reduce the calcium adverse effect rate. If a PTH ratio of 25% or less, in addition to a PTH threshold of 15 or less, were used as indications for treatment, it could decrease the need for rehospitalization for calcium imbalances.

 

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