title: Defining the syndromes of parathyroid failure after total thyroidectomy.
abstract: Acute and chronic parathyroid insufficiency syndromes are the most common complication after total thyroidectomy. Permanent hypoparathyroidism imposes an important medical burden on patient lifestyle due to the need for lifetime medication, regular visits and significant long-term costs. Its true prevalence has been underestimated due to lack of clear definitions, inadequate follow-up and conflicts of interest when reporting individual patient series. The aim of this review is to propose precise definitions for the different syndromes associated to parathyroid failure based on the follow-up and management of patients developing hypocalcemia (<8 mg/dL at 24 hours) after first-time total thyroidectomy for cancer or goiter at our unit. Short and long-term post-thyroidectomy parathyroid failure presents as three different metabolic syndromes: (I) postoperative hypocalcemia is defined as a s-Ca <8 mg/dL (<2 mmol/L) within 24 hours after surgery requiring calcium/vit D replacement therapy at the time of hospital discharge; (II) protracted hypoparathyroidism as a subnormal iPTH concentration (<13 pg/mL) and/or need for calcium/vit D replacement at 4-6 weeks; and (III) permanent hypoparathyroidism as a subnormal iPTH concentration (<13 pg/mL) and/or need for calcium/vit D replacement 1 year after total thyroidectomy. Each of these syndromes has its own pattern of recovery and should be approached with different therapeutic strategies.
authors.affiliation: 1 Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain ; 2 Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain ; 3 General and Digestive Surgery Department, Hospital de la Princesa, Madrid, Spain.
authors.forename: Leyre
authors.initials: L
authors.lastname: Lorente-Poch
authors.affiliation: 1 Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain ; 2 Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain ; 3 General and Digestive Surgery Department, Hospital de la Princesa, Madrid, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Sancho
authors.affiliation: 1 Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain ; 2 Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain ; 3 General and Digestive Surgery Department, Hospital de la Princesa, Madrid, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Muñoz-Nova
authors.affiliation: 1 Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain ; 2 Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain ; 3 General and Digestive Surgery Department, Hospital de la Princesa, Madrid, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Sánchez-Velázquez
authors.affiliation: 1 Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain ; 2 Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain ; 3 General and Digestive Surgery Department, Hospital de la Princesa, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sitges-Serra
keywords: Definitions; hypocalcemia; hypoparathyroidism; parathyroid splinting; total thyroidectomy