Beyond hypocalcemia: The impact of permanent post-operative hypoparathyroidism on patient quality of life - A narrative review

Background and Objectives: Iatrogenic hypoparathyroidism with subsequent hypocalcemia can be a debilitating consequence of thyroidectomy that often requires substantial medical management. While temporary hypocalcemia can be treated effectively in the short-term, the sequelae of long-term hypoparathyroidism and hypocalcemia is not well understood and the means to treat require a broader understanding of the complications of permanent hypocalcemia. The reduction in patient quality of life (QOL) with longstanding hypoparathyroidism is likely underestimated and underreported, though emerging studies aim to address this important topic which prioritize patient factors in addition to biochemical measures. Methods: A literature review was performed using PubMed to search all original articles published in the English language over between 2000 and March 2022 that included terms such as 'calcium', 'hypocalcemia', 'hypoparathyroidism', 'long-term management', 'quality of life', and 'supplementation'. Key Content and Findings: Hypocalcemia will be discussed as it pertains to post-operative clinical assessment, temporary and permanent medical management, and, importantly, QOL parameters related to persistent hypocalcemia. Implementation of treatment modalities to improve QOL in patients with persistent hypocalcemia will be discussed in order to outline the means by which these patients are followed in the long-term. Conclusions: This article aims to update the reader on the long-term medical and psychosocial considerations in patients with iatrogenic hypoparathyroidism which will motivate communication and treatment strategies in those who live with hypocalcemia following thyroid surgery.