Table 3.

Patients at risk for post-surgical HypoPT and risk mitigation.

Topic	Comment	References
General	Higher rates in • Thyroid cancer with central lymph node dissection • Graves’ disease Risk mitigation • Awareness • Preoperative screening of parathyroid function • Vitamin D status	102, 118, 119
Comorbidities	Obesity Gastrointestinal malabsorption, for example, post gastric bypass, severe IBDRisk mitigation • Awareness	118
Primary exploration vs repeated surgery	Higher risk in • case of repeated surgeryRisk mitigation • critical assessment for additional/repeated surgeries	102
Combined thyroid and parathyroid surgery	Thyroid and parathyroid disease often co-exist but unnoticed if not specifically evaluated Risk mitigation • preoperative evaluation for elective thyroid surgery must include parathyroid function (and vice versa)	102
Total thyroidectomy vs less extensive surgery	Risk bilateral surgery > risk unilateral surgery Risk mitigation • individualized surgical strategy	120
Bilateral cervical exploration in parathyroid disease	Risk bilateral exploration > focused PTX Risk mitigation • preoperative localization (ultrasound and nuclear medicine techniques) • exclusion of FHH (no surgery, see Q1, Primary Hyperparathyroidism)	121

FHH, familial hypocalciuric hypercalcemia; HypoPT, chronic hypoparathyroidism; PHPT, primary hyperparathyroidism; PTX, parathyroidectomy.