Permanent Hypoparathyroidism After Total Thyroidectomy Is Associated With Chronic Kidney Disease

Background Permanent hypoparathyroidism (PHypoPT) is common after total thyroidectomy (TT), yet the persistence and magnitude of renal consequences following this complication have not been characterized in large-scale populations. Methods Between January 2004 and December 2024, adult patients who underwent TT were identified from the TriNetX Research Network. Propensity matching was performed on age, demographics, and comorbidities. The primary outcomes were the incidence of CKD and burden of renal impairment; the secondary outcome was mortality. All outcomes were followed over 10 years. Results We identified 73,999 patients who underwent TT, of whom 2706 developed subsequent PHypoPT. After matching, there were 2691 patients per cohort. PHypoPT was associated with a significantly increased risk of developing CKD (HR 1.67, 95% CI: 1.39-2.02) with decreased mean estimated glomerular filtration rate (78.5 ± 26.3 mL/min/1.73 m 2 vs 83.1 ± 25.5 mL/min/1.73 m 2 , P < .01). The risk for CKD was increased in both early (HR 2.18, 95% CI: 1.75-2.71) and late (HR 2.75, 95% CI: 1.62-4.69) stages. When stratifying by indication, the increased risk persisted in patients with thyroid cancer (HR 1.70, 95% CI: 1.26-2.30), thyrotoxicosis (HR 2.41, 95% CI: 1.55-3.73), and goiter (HR 2.00, 95% CI: 1.58-2.45). There were no differences in risks for mortality. Conclusions PHypoPT after TT for both benign and malignant disease demonstrates an increased risk of CKD with worsening burden over time, indicating that this surgical complication may have systemic consequences that extend beyond postoperative care. Prospective studies should confirm such findings and assess the need for heightened surveillance in affected patients.