Assessment of Parathyroid Score as A Reliable Predictor of Hypocalcemia after Total Thyroidectomy: A Prospective Cohort Study

Background: Postoperative hypocalcemia is a common complication following total thyroidectomy, often resulting from parathyroid gland injury. Predicting hypocalcemia remains a challenge due to the limitations of biomarkers such as parathyroid hormone and serum calcium levels. The parathyroid score, an intraoperative visual assessment tool, has been proposed as a method to predict postoperative calcium homeostasis based on gland viability.Objective: This study aimed to evaluate the reliability of the parathyroid score as a predictive tool for post-thyroidectomy hypocalcemia by assessing its correlation with postoperative calcium levels, clinical symptoms.Methods: A prospective cohort study was conducted, including 100 patients who underwent total thyroidectomy at Alexandria University Hospital. A standardized parathyroid scoring system (0–12) was used intraoperatively to assess gland viability based on color and vascularity. Postoperative calcium levels (total and ionized), clinical symptoms and the need for calcium supplementation were monitored over three months. Statistical analyses, including correlation tests and regression models, were performed to evaluate the association between the parathyroid score and hypocalcemia risk.Results: Higher parathyroid scores were significantly associated with higher postoperative ionized calcium levels (p = 0.010), reduced incidence of symptomatic hypocalcemia, and decreased need for prolonged calcium supplementation. Patients with scores ≤9 exhibited greater fluctuations in ionized calcium levels and were more likely to require calcium supplementation beyond one month. Clinical symptoms such as circumoral numbness were significantly more common in patients with lower parathyroid scores (p = 0.001). Despite these findings, parathyroid score did not significantly influence total serum calcium levels or hospital stay duration.Conclusion: The parathyroid score is a simple, effective, and cost-efficient intraoperative tool for predicting postoperative hypocalcemia in thyroidectomy patients. It allows for early identification of at-risk patients, facilitating targeted calcium supplementation and reducing unnecessary interventions.