Permanent hypoparathyroidism after total thyroïdectomy

Postoperative hypoparathyroidism is a major complication of total thyroidectomy. It results from the accidental removal and/or devascularization of one or more parathyroid glands. Its persistence 6 to 12 months after surgery defines permanent hypoparathyroidism, with a cumulative prevalence in recent series of 4.1% [4.0 - 4.3]. The prevention of this complication after total thyroidectomy is the subject of recent recommendations following the AFCE/SFE/SFMN consensus on the management of thyroid nodules. In a recent multicenter prospective study, we investigated the consequences of this complication after total thyroidectomy (45 hypoparathyroid patients) on quality of life (SF-36 self-questionnaire) and voice quality (VHI questionnaire) in comparison to a control group of patients who had undergone total thyroidectomy without postoperative hypoparathyroidism (96 patients). This study revealed a significant impairment in both the physical and mental dimensions of quality of life in hypoparathyroid patients, as well as an alteration in the quality of their voice. In hypoparathyroid patients, myalgias, arthralgias, paresthesias, tetanic crises, anxiety, and exhaustion were present in more than 50% of patients and were responsible for a decrease in their quality of life. The presence of at least two of these symptoms or an altered VHI score was significantly associated with a mental score alteration (multivariate analysis). This study underscores the importance of preventing this complication.