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Incidence Of Hypoparathyroidism After Total Thyroidectomy for Benign Goitres. A Systematic Review

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Ghani MT, Haq HMI ul, Rehman IU, Malik HA. Incidence Of Hypoparathyroidism After Total Thyroidectomy for Benign Goitres. A Systematic Review . JRMC [Internet]. 2023 Jun. 24 [cited 2024 Apr. 16];27(2). Available from:


Objective:  systematic review assessed the overall incidence of hypoparathyroidism after Total thyroidectomy (TT) for benign goitres.

Methods: A systematic search of PubMed, google scholar, Cochrane, and Pakmedinet under PRISMA (preferred reporting items for systematic reviews and Meta-analyses) guidelines was performed. All studies during the last 50 years where TT was performed for benign goitres and post-operative hypoparathyroidism was assessed were included.  The total incidence of both transient and permanent hypoparathyroidism was calculated after TT for benign goitres. The risk of bias was also assessed.

Results: Twelve studies were included in total including eight retrospective, three prospective observational studies, and one randomized trial. Three studies were from Turkey, 2 from Pakistan, 2 from Greece, and one each from Saudi Arabia, India, Denmark, Egypt, and the USA. 2809 TT were performed for benign goitres. Overall Transient hypoparathyroidism (THP) was noted in 290 (10%) patients while permanent hypoparathyroidism (PHP) was noted in 33(1.17%) patients. The highest incidence of permanent hypoparathyroidism was 17% in one study while the lowest was 0% in three studies. The highest incidence of transient hypoparathyroidism was 28.5% in one study while the lowest incidence was 2.5%. The risk of bias was high.

Conclusion: TT for benign goitres is associated with 1.17 % overall risk (range 0%-17%) of PHP and 10% (range 2.5%-28.5%) of THP.


Giuffrida D, et al. Thyroidectomy as Treatment of Choice for Differentiated Thyroid Cancer. Int J Surg Oncol. 2019; Oct(13):2715260. doi: 10.1155/2019/2715260.

Gangappa RB, Kenchannavar MB, Chowdary PB, Patanki AM, Ishwar M. Total Thyroidectomy for Benign Thyroid Diseases: What is the Price to be Paid? J Clin Diagn Res. 2016; 10(6):04-7. doi: 10.7860/JCDR/2016/18733.7991.

Mintziras I, et al. Heavier Weight of Resected Thyroid Specimen Is Associated With Higher Postoperative Morbidity in Benign Goitre. J Clin Endocrinol Metab. 2022; Jun (16):2762-69. doi: 10.1210/clinem/dgac214. PMID: 35390148..

Bartsch DK, Dotzenrath C, Vorländer C, Zielke A, Weber T, Buhr HJ, Klinger C, Lorenz K, The StuDoQ/Thyroid Study Group TSS. Current Practice of Surgery for Benign Goitre-An Analysis of the Prospective DGAV StuDoQ|Thyroid Registry. J Clin Med.2019; Apr(8): 477. doi: 10.3390/jcm8040477.

Martinez JG, González M, Hernández Q, Rodríguez MA, Torregrosa N, Gil E, Cascales PA, Delgado MA, Sancho J, Lopez-Lopez V, Rodriguez JM. Goitre surgery recommendations in sub-Saharan Africa in humanitarian cooperation. Laryngoscope Investig Otolaryngol. 2022; 7(2):417-24. doi: 10.1002/lio2.764.

Bartsch DK, Luster M, Buhr HJ, Lorenz D, Germer CT, Goretzki PE; German Society for General and Visceral Surgery. Indications for the Surgical Management of Benign Goitre in Adults. Dtsch Arztebl Int. 2018; Jan (8): 115-17. doi: 10.3238/arztebl.2018.0001.

Ciftci F, Sakalli E, Abdurrahman I. Total versus bilateral subtotal thyroidectomy for benign multi-nodular goitre. Int J Clin Exp Med. 2015; 8(3):4596-600.

Jin S, Sugitani I. Narrative review of management of thyroid surgery complications. Gland Surg. 2021; 10(3):1135-46. doi: 10.21037/gs-20-859. PMID: 33842257; PMCID: PMC8033047

Jensen PV, Jelstrup SM, Homøe P. Long-term outcomes after total thyroidectomy. Dan Med J. 2015; 62(11): 51-56. PMID: 26522480

Ritter K, Elfenbein D, Schneider DF, Chen H, Sippel RS. Hypoparathyroidism after total thyroidectomy: incidence and resolution. J Surg Res. 2015; 197(2):348-53. doi: 10.1016/j.jss.2015.04.059.

Diez JJ, et al. Permanent postoperative hypoparathyroidism: an analysis of prevalence and predictive factors for adequacy of control in a cohort of 260 patients. Gland Surg. 2020; 9(5):1380-88. doi: 10.21037/gs-20-288. PMID: 33224813; PMCID: PMC7667118.

Bergenfelz A, Nordenstrom E, Almquist M. Morbidity in patients with permanent hypoparathyroidism after total thyroidectomy. Surgery. 2020; 167(1): 124-8. Doi:10.1016/j.surg.2019.06.056.Epub 2019 sep 27 PMID:31570150S

Nawrot I, Pragacz A, Pragacz K, Grzesiuk W, Barczyński M. Total thyroidectomy is associated with increased prevalence of permanent hypoparathyroidism. Med Sci Monit. 2014; 20:1675–81.

Vassiliou I, Tympa A, Arkadopoulos N, Nikolakopoulos F, Petropoulou T, Smyrniotis V. Total thyroidectomy as the single surgical option for benign and malignant thyroid disease: a surgical challenge. Arch Med Sci. 2013; 9(1):74-8. doi: 10.5114/aoms.2013.33065. Epub 2013 Feb 18. PMID: 23515861; PMCID: PMC3598148

Page MJ, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; Mar 29:371-2. doi: 10.1136/bmj.n71. PMID: 33782057; PMCID: PMC8005924.

Alharbi F, Ahmed MR. Experience of thyroid surgery at tertiary referral centers in Jazan Hospitals, Saudi Arabia. Interv Med Appl Sci. 2018; 10(4):198-201. doi: 10.1556/1646.10.2018.37.

Latif S, Altaf H, Waseem S, Farooqui F, Altaf OS, Amir M. A retrospective study of complications of total thyroidectomy; is it a safe approach for benign thyroid conditions. J Pak Med Assoc. 2019; 69(10):1470-73. PMID: 31622299

Ozbas S, Kocak S, Aydintug S, Cakmak A, Demirkiran MA, Wishart GC. Comparison of the complications of subtotal, near total and total thyroidectomy in the surgical management of multinodular goitre. Endocr J. 2005; 52(2): 199-05. doi: 10.1507/endocrj.52.199.

Efremidou EI, Papageorgiou MS, Liratzopoulos N, Manolas KJ. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg. 2009; ; 52(1):39-44. PMID: 19234650; PMCID: PMC2637645.

Koyuncu A, Dökmetas HS, Turan M, Aydin C, Karadayi K, Budak E, Gökgöz S, Sen M. Comparison of different thyroidectomy techniques for benign thyroid disease. Endocr J. 2003; 50(6) :723-7. doi: 10.1507/endocrj.50.723. PMID: 14709843.

Sewefy AM, Tohamy TA, Esmael TM, Atyia AM. Intra-capsular total thyroid enucleation versus total thyroidectomy in treatment of benign multinodular goitre. A prospective randomized controlled clinical trial. Int J Surg. 2017; 45:29-34.

Lodhi M, Kanwal S, Akram M, Chaman D, Saeed Y, Hussain R. Total thyroidectomy in Benign multinodular goitre. Annal Punjab Med Coll. 2010; 4(1): 39-43.

Bauer PS, Murray S, Clark N, Pontes DS, Sippel RS, Chen H. Unilateral thyroidectomy for the treatment of benign multinodular goitre. J Surg Res. 2013; 184(1):514-8.

Wells G, Stang, Andreas, Stephan J, Charles P. Case Study in Major Quotation Errors: A Critical Commentary on the Newcastle–Ottawa Scale. European Journal of Epidemiology. 2018; 33(11):1025–31.

Minozzi S, Dwan K, Borrelli F, Filippini G. Reliability of the revised Cochrane risk-of-bias tool for randomised trials (RoB2) improved with the use of implementation instruction. J Clin Epidemiol. 2022; Jan(141): 99-105. doi: 10.1016/j.jclinepi.2021.09.021. Epub 2021 Sep 16. PMID: 34537386.

Bage AM, Kalatharan P. Role of Total Thyroidectomy in Painful (Symptomatic) Hashimoto's Thyroiditis: Descriptive Study. Indian J Otolaryngol Head Neck Surg. 2021; 73(3):296-03. doi: 10.1007/s12070-020-02114-2.

Frank ED, Park JS, Watson W, Chong E, Yang S, Simental AA. Total thyroidectomy: Safe and curative treatment option for hyperthyroidism. Head Neck. 2020; 42(8):2123-2128. doi: 10.1002/hed.26148. Epub 2020 Mar 21. PMID: 32199035.

Medas F, Tuveri M, Canu GL, Erdas E, Calò PG. Complications after reoperative thyroid surgery: retrospective evaluation of 152 consecutive cases. Updates Surg. 2019; 71(4):705-710. doi: 10.1007/s13304-019-00647-y. Epub 2019 Apr 1. PMID: 30937820.

Pauleau G, Goin G, Cazeres C, Sebag F, Balandraud P. Chirurgie de la thyroïde applicable dans les pays en développement [Thyroid surgery applicable in developing countries]. Med Sante Trop. 2015; 25(1):23-8. French. doi: 10.1684/mst.2014.0364.

Yakubouski SU, Kandratsenka HH, Salko OB, Kuzmenkova EL. Epidemiology of benign thyroid disorders in the adult population of the Republic of Belarus: analysis of nationwide statistics 2009 to 2019. Probl Endokrinol(Mosk). 2022; 68(3): 30-43 doi: 10.14341/probl12844.

Zekarias B, Mesfin F, Mengiste B, Tesfaye A, Getacher L. Prevalence of Goitre and Associated Factors among Women of Reproductive Age Group in Demba Gofa Woreda, Gamo Gofa Zone, Southwest Ethiopia: A Community-Based Cross-Sectional Study. J Nutr Metab. 2020; Oct (31): 5102329. doi: 10.1155/2020/5102329.

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