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DOI: 10.1016/j.otoeng.2019.08.002
Available online 12 September 2019
Executive Summary of the SEORL CCC-SEEN Consensus Document on Post-thyroidectomy Hypoparathyroidism
Resumen ejecutivo del documento de consenso SEORL CCC-SEEN sobre hipoparatiroidismo postiroidectomía
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Alejandro Castroa,
Corresponding author
, Amelia Oleagab, Pablo Parente Ariasc, Miguel Pajab, Elisa Gil Carcedod, Cristina Álvarez Escoláe
a Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, Spain
b Servicio de Endocrinología y Nutrición, Hospital Universitario de Basurto, Bilbao, Spain
c Servicio de Otorrinolaringología, Hospital Universitario Lucus Augusti, Lugo, Spain
d Servicio de Otorrinolaringología, Hospital Universitario Río Hortega, Valladolid, Spain
e Servicio de Endocrinología y Nutrición, Hospital Universitario La Paz, Madrid, Spain
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Table 1. Stratification into Risk Groups for Symptomatic HypoPTH-PT According to the Cut-off Points Established in the Studies of Hospital Universitario La Paz.
Table 2. Objectives of the Treatment of Chronic HypoPTH-PT.
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Abstract

Hypoparathyroidism is the most common complication after total or completion thyroidectomy. It is defined as the presence of hypocalcemia accompanied by low or inappropriately normal parathyroid hormone (PTH) levels. Acute hypocalcemia is a potential lethal complication. Hypocalcemia treatment is based on endovenous or oral calcium supplements as well as oral calcitriol, depending on the severity of the symptoms. The risk of clinical hypocalcemia after bilateral thyroidectomy is considered very low if postoperative intact PTH decrease less than 80% with respect to preoperative levels. These patients could be discharged home without treatment, although this threshold may vary between institutions, and we recommend close surveillance in cases with increased risk (Graves disease, large goiters, reinterventions or evidence of parathyroid gland removal). Long-term treatment objectives are to control the symptoms and to keep serum calcium levels at the lower limit of the normal range, while preserving the calcium phosphate product and avoiding hypercalciuria.

Keywords:
Hypocalcemia
Hypoparathyroidism
Thyroidectomy
Parathyroid hormone
Resumen

El hipoparatiroidismo es la complicación más frecuente tras la tiroidectomía total. Se define por la presencia de hipocalcemia con unos niveles de hormona paratiroidea (PTH) bajos o inadecuadamente normales. La hipocalcemia aguda es una complicación potencialmente grave. Su tratamiento se basa, según la gravedad del cuadro, en la administración de calcio por vía oral o intravenosa, pudiendo requerir asimismo calcitriol oral. El riesgo de hipocalcemia sintomática tras una tiroidectomía es muy bajo si la PTH postoperatoria desciende menos del 80% respecto de la preoperatoria. Estos pacientes podrían ser dados de alta sin tratamiento, aunque los umbrales son variables entre laboratorios y recomendamos extremar la vigilancia en los casos de riesgo aumentado (enfermedad de Graves, grandes bocios, reintervenciones o constancia de la extirpación de alguna paratiroides). El tratamiento a largo plazo busca controlar los síntomas manteniendo la calcemia en el límite bajo de la normalidad, vigilando el producto calcio-fósforo y la aparición de hipercalciuria.

Palabras clave:
Hipocalcemia
Hipoparatiroidismo
Tiroidectomía
Hormona paratiroidea

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