title: Hormone replacement after thyroid and parathyroid surgery.
abstract: BACKGROUND
  Hypothyroidism and hypocalcemia are common after thyroid and parathyroid surgery. In this article, the authors provide clinically-oriented recommendations to help surgeons, general practitioners, internists, and endocrinologists give their affected patients adequate hormone replacement therapy.
  
  
  METHODS
  Selective evaluation of original articles and reviews that were retrieved by a PubMed search over the years 1980 to 2010, as well as of the recommendations of medical societies including the Endocrine Society (USA), the German Society for Endocrinology (Deutsche Gesellschaft für Endokrinologie), and the American and European Thyroid Associations.
  
  
  RESULTS
  Important issues in L-thyroxine replacement therapy include: the selection of the hormone preparation (T4 or T4/T3), combination with iodine (yes/no), the definition of therapeutic TSH ranges (particularly after surgery for thyroid cancer), the extent of remaining thyroid tissue after goiter surgery and its significance, underlying diseases, and drug interactions. The major issues in the treatment of postoperative hypoparathyroidism are: the selection of suitable calcium and vitamin D preparations, the definition of therapeutic goals, the treatment of hypercalciuria and hyperphosphatemia, and the option of recombinant parathormone therapy.
  
  
  CONCLUSIONS
  Effective treatment requires an appropriate choice of medication and an understanding of its pharmacokinetics as well as of the possible effects of the patient's underlying disease, comorbidities, and other medications on its absorption and metabolism.
authors.affiliation: Klinik und Poliklinik für Innere Medizin I, Universität Regensburg, 93042 Regensburg, Germany. andreas.schaeffler@klinik.uni-regensburg.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Schäffler
mesh_terms: D000284:Administration, Oral; D002119:Calcium Carbonate / Q000097:blood / Q000627:therapeutic use; D019355:Calcium Citrate / Q000097:blood / Q000627:therapeutic use; D002125:Calcium Gluconate / Q000097:blood / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D018565:Food-Drug Interactions; D006207:Half-Life; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D006996:Hypocalcemia / Q000097:blood / Q000188:drug therapy*; D007037:Hypothyroidism / Q000097:blood / Q000188:drug therapy*; D007262:Infusions, Intravenous; D007455:Iodine / Q000008:administration & dosage / Q000097:blood; D010279:Parathyroid Diseases / Q000097:blood / Q000601:surgery*; D010281:Parathyroid Hormone / Q000097:blood / Q000627:therapeutic use; D016105:Parathyroidectomy; D011183:Postoperative Complications / Q000097:blood / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000627:therapeutic use; D013959:Thyroid Diseases / Q000097:blood / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000097:blood / Q000601:surgery*; D013965:Thyroidectomy; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood / Q000627:therapeutic use; D016896:Treatment Outcome; D014284:Triiodothyronine / Q000097:blood / Q000627:therapeutic use; D014807:Vitamin D / Q000097:blood / Q000627:therapeutic use
chemical_list: D010281:Parathyroid Hormone; D011994:Recombinant Proteins; D014284:Triiodothyronine; D014807:Vitamin D; D013972:Thyrotropin; D007455:Iodine; D002119:Calcium Carbonate; D019355:Calcium Citrate; D013974:Thyroxine; D002125:Calcium Gluconate