Risk Factors for Hypoparathyroidism and Hypocalcemia Following Total Thyroidectomy: A Single-Center Retrospective Study

Objective Hypoparathyroidism and hypocalcemia are common complications following total thyroidectomy (TT). This study aimed to evaluate the risk of post-total thyroidectomy hypoparathyroidism and hypocalcemia through a large-simple single-center analysis. Methods In this retrospective study, consecutive patients underwent total thyroidectomy from May 2021 to September 2022 were included. Postoperative parathyroid hormone (PTH) level and serum calcium levels were evaluated within 24 hours. Univariate and multivariate analysis were performed for assessing risk factors for developing hypoparathyroidism and hypocalcemia after total thyroidectomy. Results A total of 1065 patients undergoing total thyroidectomy who met the inclusion criteria were enrolled in this study. Among the patients, 460 patients (43.2%) developed hypoparathyroidism after surgery, and a total 325 patients (30.5%) developed hypocalcemia. After multivariate analysis, the mean risk factors related to hypoparathyroidism are female (OR = 1.65, p < 0.001), inadvertent parathyroidectomy (OR = 2.26, p = 0.004), thyroid microcarcinoma (OR = 1.55, p = 0.003) and capsule invasion (OR = 1.39, p = 0.034). Meanwhile, the mean risk factors related to hypocalcemia are female (OR = 1.94, p < 0.001) and inadvertent parathyroidectomy (OR = 2.01, p = 0.011). Conclusion Transient hypoparathyroidism and hypocalcemia are relatively common complications following total thyroidectomy. Female, incidental parathyroid gland excision, papillary thyroid microcarcinoma, and capsular invasion were identified as independent risk factors for hypoparathyroidism and hypocalcemia. Prophylactic calcium supplementation in high-risk populations may reduce the incidence of severe perioperative complications.