Batna Journal of Medical Sciences
Volume 13, Numéro 2, Pages 181-186
2026-05-19

Predictors Of Severe Postoperative Hypocalcemia Following Parathyroidectomy For Primary Hyperparathyroidism : A Retrospective Cohort Study



Authors : Khalouf Mohamed Abderaouf . Seridj Nardjess . Rabehi Leyla . Boudjella Mohamed Lotfi . Hamoudi Djamila . Louddani Abir . Rabehi Hassan .

Abstract

Aims: Postoperative hypocalcemia is a frequent complication after parathyroidectomy for primary hyperparathyroidism (PHPT), ranging from transient asymptomatic drops to prolonged hungry bone syndrome (HBS). This study aimed to identify independent predictors of severe postoperative hypocalcemia using a composite clinical biological definition and to evaluate the role of early postoperative parathyroid hormone (PTH) kinetics. Patients and Methods: A retrospective cohort study was conducted on 166 consecutive patients who underwent parathyroidectomy for PHPT between January 2019 and May 2025. Severe hypocalcemia was defined within the first three postoperative days as: (a) corrected serum calcium <70 mg/L, OR (b) calcium <75 mg/L with clinical symptoms (perioral/digital paresthesia, Trousseau’s sign, muscle cramps, confusion), OR (c) need for intravenous calcium infusion. Preoperative, surgical, and early postoperative variables (percentage PTH drop from preoperative to day 1) were analyzed. Multivariate analysis used Firth logistic regression to avoid overfitting, limiting the model to three preselected variables. Results: Severe hypocalcemia occurred in 12 patients (7.2%); Hungry bone syndrom in 8 (4.8%). Independent predictors were: adenoma weight >2 g (OR = 4.0, 95% CI 1.4–11.2, p = 0.008), bilateral neck exploration (OR = 3.5, 95% CI 1.2–10.1, p = 0.02), and a >80% drop in PTH from preoperative to day 1 (OR = 5.0, 95% CI 1.7–14.5, p = 0.003). The optimal cut off for PTH drop was 75% (AUC = 0.81). Preoperative vitamin D deficiency and osteoporosis were not independent after adjustment. Conclusion: Adenoma weight >2 g, bilateral neck exploration, and a >75% drop in PTH by postoperative day 1 independently predict severe hypocalcemia. Early postoperative PTH measurement is a simple, valuable tool to guide prophylactic calcium and calcitriol therapy.

Keywords

Primary hyperparathyroidism ; postoperative hypocalcemia ; hungry bone syndrome ; parathyroidectomy ; PTH kinetics

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