Incidental parathyroidectomy during thyroid surgery and postoperative hypocalcemia: a multicenter retrospective cohort study.
4 affiliations
- 1Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- 2Department of Surgery, Arryan Hospital, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia.
- 3Department of Surgery, King AbdulAziz Medical City, National Guard, Riyadh, Saudi Arabia.
- 4College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Abstract
Postoperative hypocalcemia is the most frequent metabolic complication of thyroidectomy, and incidental parathyroidectomy (IPT) is a commonly cited but incompletely characterized contributor. Despite a substantial published literature, the independent clinical impact of IPT on postoperative calcium homeostasis remains debated, and multicenter data from high-volume endocrine surgery settings in Saudi Arabia are lacking. A retrospective multicenter cohort study was conducted across high-volume endocrine surgery units in Saudi Arabia between January 2020 and December 2024. A total of 455 patients who underwent total or subtotal thyroidectomy were included. IPT was defined histopathologically. Predictors of IPT and of postoperative hypocalcemia were assessed using pre-specified multivariable logistic regression, with cluster-robust standard errors accounting for the multicenter structure. Adjusted odds ratios (aORs) with 95% confidence intervals are reported. IPT was confirmed in 145 of 455 patients (31.9%). In a pre-specified multivariable model, age ≥60 years was associated with IPT with conventional standard errors (aOR 1.72, 95% CI 1.04-2.85; p = 0.035) but not after accounting for clustering by operating surgeon (aOR 1.72, 95% CI 0.70-4.24; p = 0.24); no variable was a robust independent predictor. When postoperative hypocalcemia was modeled directly, IPT was not associated with it (aOR 0.94, 95% CI 0.44-2.00; p = 0.87), whereas total thyroidectomy was the dominant predictor (aOR 4.82, 95% CI 1.44-16.07; p = 0.011). Preoperative parathyroid hormone was available for only 112 of 455 patients (24.6%) and, using an appropriate non-parametric test, did not differ significantly by IPT status (4.00 ± 1.98 vs. 5.73 ± 4.88 pg/mL; p = 0.14, Mann-Whitney U test). IPT was not associated with calcium supplementation requirement or readmission for hypocalcemia. IPT occurred in nearly one-third of patients but did not predict postoperative hypocalcemia; the extent of surgery, specifically total thyroidectomy, was the principal determinant of postoperative calcium disturbance. Age and preoperative parathyroid hormone were not robust independent correlates once clustering and appropriate testing were applied. These results support universal postoperative calcium monitoring after total thyroidectomy rather than reliance on histologic parathyroid findings.
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BibTeX
@article{alsaleh2026incidental,
title = {{Incidental parathyroidectomy during thyroid surgery and postoperative hypocalcemia: a multicenter retrospective cohort study.}},
author = {Nuha Alsaleh and Khadija AlKhawaja and Abdullah S Al-Darwish and Saad Alshehri and Ammar Alzahim and Osama N Almubadel and Hala Abu-Qasem and Reema M Almutairi and Reem AlaaEldeen Ahmed},
journal = {Frontiers in surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1946603},
url = {https://europepmc.org/article/MED/42952700},
note = {CC BY},
}
RIS
TY - JOUR
TI - Incidental parathyroidectomy during thyroid surgery and postoperative hypocalcemia: a multicenter retrospective cohort study.
AU - Nuha Alsaleh
AU - Khadija AlKhawaja
AU - Abdullah S Al-Darwish
AU - Saad Alshehri
AU - Ammar Alzahim
AU - Osama N Almubadel
AU - Hala Abu-Qasem
AU - Reema M Almutairi
AU - Reem AlaaEldeen Ahmed
PY - 2026
DA - 2026/10/14
JO - Frontiers in surgery
DO - 10.3389/fsurg.2026.1946603
UR - https://europepmc.org/article/MED/42952700
AB - Postoperative hypocalcemia is the most frequent metabolic complication of thyroidectomy, and incidental parathyroidectomy (IPT) is a commonly cited but incompletely characterized contributor. Despite a substantial published literature, the independent clinical impact of IPT on postoperative calcium homeostasis remains debated, and multicenter data from high-volume endocrine surgery settings in Saudi Arabia are lacking. A retrospective multicenter cohort study was conducted across high-volume endocrine surgery units in Saudi Arabia between January 2020 and December 2024. A total of 455 patients who underwent total or subtotal thyroidectomy were included. IPT was defined histopathologically. Predictors of IPT and of postoperative hypocalcemia were assessed using pre-specified multivariable logistic regression, with cluster-robust standard errors accounting for the multicenter structure. Adjusted odds ratios (aORs) with 95% confidence intervals are reported. IPT was confirmed in 145 of 455 patients (31.9%). In a pre-specified multivariable model, age ≥60 years was associated with IPT with conventional standard errors (aOR 1.72, 95% CI 1.04-2.85; p = 0.035) but not after accounting for clustering by operating surgeon (aOR 1.72, 95% CI 0.70-4.24; p = 0.24); no variable was a robust independent predictor. When postoperative hypocalcemia was modeled directly, IPT was not associated with it (aOR 0.94, 95% CI 0.44-2.00; p = 0.87), whereas total thyroidectomy was the dominant predictor (aOR 4.82, 95% CI 1.44-16.07; p = 0.011). Preoperative parathyroid hormone was available for only 112 of 455 patients (24.6%) and, using an appropriate non-parametric test, did not differ significantly by IPT status (4.00 ± 1.98 vs. 5.73 ± 4.88 pg/mL; p = 0.14, Mann-Whitney U test). IPT was not associated with calcium supplementation requirement or readmission for hypocalcemia. IPT occurred in nearly one-third of patients but did not predict postoperative hypocalcemia; the extent of surgery, specifically total thyroidectomy, was the principal determinant of postoperative calcium disturbance. Age and preoperative parathyroid hormone were not robust independent correlates once clustering and appropriate testing were applied. These results support universal postoperative calcium monitoring after total thyroidectomy rather than reliance on histologic parathyroid findings.
SN - 2296-875X
ER -