# Reflections on prevention and treatment of post-thyroidectomy hypoparathyroidism: current management approaches and future prospects

## TL;DR

This paper reviews the causes, diagnosis, and treatment of hypoparathyroidism after thyroid surgery, and highlights new methods to prevent and manage this condition.

## Contribution

The paper introduces recent advancements in parathyroid gland preservation techniques and novel therapies like palopegteriparatide and parathyroid organoids.

## Key findings

- Various imaging techniques like near-infrared autofluorescence and indocyanine green aid in identifying and preserving parathyroid glands during surgery.
- New therapies such as palopegteriparatide and parathyroid organoids show promise in treating hypoparathyroidism.
- The paper identifies current knowledge gaps and emphasizes the need for improved awareness and management of postoperative hypoparathyroidism.

## Abstract

Postoperative hypoparathyroidism (hypoPT) is one of the predominant and severe complications of thyroid surgery. This condition manifests as suboptimal circulatory levels of parathyroid hormone (PTH), engendering multifaceted systemic perturbations. This comprehensive review elucidates the underlying pathophysiological mechanisms and clinical presentations associated with hypoparathyroidism. Moreover, methodologies for the precise recognition and preservation (naked eye, near-infrared autofluorescence, indocyanine green, carbon nanoparticles, and mitoxantrone hydrochloride) of the parathyroid gland during thyroid surgery have been explored, along with recent therapeutic innovations (palopegteriparatide and parathyroid organoids). Finally, this review prospects and interventions via organoids are contemplated. The aim of the literature is to recapitulate the knowledge and the gaps in this field, increasing awareness of postoperative hypoparathyroidism, and improve the prognosis for patients afflicted with hypoparathyroidism.