Strategies to Maintain A Normocalcemic, Asymptomatic Status Following Total Thyroidectomy

Introduction: Hypoparathyroidism is an unintended complication of total thyroidectomy that may result from accidental parathyroid gland excision or devascularization.However, its management remains clinically and surgically challenging.We aimed to investigate associations between postoperative hypoparathyroidism and parathyroid gland excision, vascular integrity, and early replacement therapy.Methods: We retrospectively analyzed 536 patients who underwent total thyroidectomy between August 2022 and April 2025.Patients with records of preoperative and postoperative parathyroid hormone (PTH) and calcium levels , including 4-and 8-week values, were included in the study.The effects of calcium and active vitamin D replacement therapies were evaluated.Results: Transient hypoparathyroidism occurred in 18.7% of patients; no cases of permanent hypoparathyroidism were detected.The mean PTH reduction rate was significantly higher in the hypoparathyroidism group (71.71%) than in the non-hypoparathyroidism group (38.44%; p