AACE MENA 2025-Surgical Hypoparathyroidism

Video Transcription

Video Summary

The presentation focused on surgical hypoparathyroidism, a complication following thyroid and parathyroid surgery. The speaker shared a case highlighting diagnostic challenges and the risk of persistent disease despite initial apparent surgical success. Emphasis was placed on the importance of surgeon experience and volume, with data showing that performing at least 25 thyroidectomies annually significantly reduces hypoparathyroidism risk. High-volume surgeons achieve better outcomes and fewer complications. New intraoperative technologies such as near-infrared autofluorescence help identify parathyroid glands, while indocyanine green fluorescence angiography assesses gland viability to inform surgical decisions about autotransplantation. The speaker stressed the delicate vascular anatomy of parathyroids, which makes them vulnerable to injury, particularly via thermal devices used in surgery. Postoperative monitoring of parathyroid hormone (PTH) within 24 hours guides individualized management, including calcium and activated vitamin D supplementation to prevent symptomatic hypocalcemia. Hypomagnesemia correction is also essential. A co-management approach between surgeons and endocrinologists reduces readmissions and improves outcomes. Finally, surgeons were encouraged to perform less extensive surgery (e.g., lobectomy when appropriate) to reduce hypoparathyroidism rates and to refer patients to high-volume surgeons to optimize care and minimize complications.

Keywords

surgical hypoparathyroidism

thyroid surgery

parathyroid surgery

surgeon experience

near-infrared autofluorescence

indocyanine green fluorescence angiography

postoperative parathyroid hormone monitoring

calcium and vitamin D supplementation