Persistent Hyperphosphataemia as a Surrogate Marker of Permanent Hypoparathyroidism After Total Thyroidectomy in a Resource-Limited Setting.

Authors

Poongkodi Karunakaran, Rangarajan Rajamanickam, Rajeev Parameswaran

Published in

World journal of surgery. Nov 13, 2026. Epub Nov 13, 2026.

Abstract

Permanent hypoparathyroidism remains a significant complication after total thyroidectomy (TT), particularly with rising thyroid cancer incidence and increasing surgical extent. Long-term consequences include hypocalcaemic symptoms, renal impairment, cardiovascular morbidity, neurocognitive dysfunction, reduced quality of life, and increased healthcare utilization. Although intact parathyroid hormone (iPTH) is the standard biomarker for diagnosis and surveillance, its availability and affordability remain limited in many low-resource settings. This prospective study evaluated the utility of serum phosphate as a surrogate marker for permanent hypoparathyroidism after TT.
This cohort study compared patients with and without permanent hypoparathyroidism, defined as iPTH < 10 pg/mL persisting beyond 6 months post-TT. Demographic, clinico-pathological, and biochemical variables, including serum calcium, phosphate, iPTH, and 25-hydroxyvitamin D (25OHD), were analyzed at baseline, postoperative day 2 (POD2), and 6 months.
Among 328 patients (mean age 38.7 years; 77.1% women), transient postoperative hypoparathyroidism occurred in 195 (59.5%) and permanent hypoparathyroidism in 18 (5.5%). Multivariable analysis identified POD2 iPTH (odds ratio 10.7, 95% confidence intervals 1.3-88.1); parathyroid autotransplantation (OR 8.4[1.6-43.5]); six-month phosphate (OR 3.9[1.2-13.5]); six-month 25OHD level (OR 3.2[1.03-10.1]) and POD2 calcium (OR 1.7[1.0-3.0]) as independent predictors, each p < 0.05. In receiver operating characteristic analysis, both POD2 iPTH < 6 pg/mL (AUC = 0.781) and 6-month phosphate > 4.9 mg/dL (AUC = 0.743) demonstrated good discriminatory performance (p < 0.001) and were comparable by DeLong's test (p = 0.671).
Postoperative iPTH below 6 pg/mL is the principal marker for early risk stratification of permanent hypoparathyroidism following TT, whereas persistent hyperphosphataemia may serve as a surrogate biochemical marker during long-term surveillance.

PMID:
43031272
Bibliographic data and abstract were imported from PubMed on 14 Nov 2026.

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