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Actual prevalence of hypoparathyroidism after total thyroidectomy: a health insurance claims-database study

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Persistent hypoparathyroidism (hypoPT) is a major complication of total thyroidectomy. Nonetheless, previous reports may have underestimated the prevalence of hypoPT due to patient selection bias. We aimed to estimate the actual prevalence of persistent hypoPT after total thyroidectomy and to find predictive factors for postoperative hypoPT.


This study retrospectively reviewed data from a health insurance claims-based database provided by the Japan Medical Data Center Co., Ltd. From 2009 to 2019, 2388 patients who underwent total thyroidectomy were identified using the medical procedure codes. Persistent hypoPT was defined as the prescription of active vitamin D supplements for >1 year postoperatively and the assignment of hypoPT codes. The prevalence of persistent hypoPT was estimated at two different levels: minimum and maximum estimations with or without postoperative osteoporosis and/or renal failure codes. Correlates for persistent hypoPT were investigated among several demographic and clinical variables.


Of the 2388 patients, 1752 (73.4%) were women with a mean age of 45 years. The types of diseases were: benign thyroid disease (n = 235), malignant thyroid tumors (n = 1570), Graves ‘ disease (n = 558), and malignancy combined with Graves’ disease (n = 25). The minimum and the maximum estimation of the prevalence of persistent hypoPT were 15.0 and 20.3%, respectively. Multivariate logistic regression analysis showed that the malignant tumor (odds ratio, 1.8) independently correlated with persistent hypoPT.


The prevalence of persistent hypoPT after total thyroidectomy estimated by the claims-based database was higher than previously recognized. Comprehensive attempts to preserve parathyroid function, especially in malignant diseases, are essential.

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Fig. 1: Minimum and maximum prevalence of persistent hypoparathyroidism after total thyroidectomy.

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We thank Dr. Kazuya Fujiwara (Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan) for introducing us to the JMDC database and teaching us how to use it.

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T.T., K.Y., R.S., Y.U. and A.H. were involved in study design and data interpretation. T.T. was involved in the data analysis. All authors commented and critically revised the drafts of the manuscript, and approved the final version.

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Correspondence to Takeshi Takahashi.

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Takahashi, T., Yamazaki, K., Shodo, R. et al. Actual prevalence of hypoparathyroidism after total thyroidectomy: a health insurance claims-database study. Endocrine 78, 151–158 (2022).

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