J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website https://jem.elmerpub.com

Original Article

Volume 16, Number 3, June 2026, pages 157-165

Long-Term Postsurgical Hypoparathyroidism: Subtle Musculoskeletal Alterations and Marked Quality-of-Life Impairment

↓ Figure 1. SF-36v2 domain scores in healthy controls, postsurgical hypothyroidism (hypoT), and postsurgical hypoparathyroidism with hypothyroidism (hypoPT + T). Data are presented as mean ± SD. **P < 0.01 vs. control group. ^†P < 0.05 vs. hypoT group.

↓ Figure 2. WHO-5 well-being index scores in healthy controls, postsurgical hypothyroidism (hypoT), and postsurgical hypoparathyroidism with hypothyroidism (hypoPT + T). Data are presented as mean ± SD. *P < 0.01 vs. control and hypoT groups.

↓ **Table 1.** Demographic Characteristics of Groups
	Control (n = 30) (mean ± SD)	HypoT (n = 30) (mean ± SD)	HypoPT + T (n = 30) (mean ± SD)	P
*Statistically significant differences (P < 0.05). BMI: body mass index; FFM: fat-free mass; HypoT: postsurgical hypothyroidism; HypoPT + T: postsurgical hypoparathyroidism and hypothyroidism; SD: standard deviation.
Gender (female/male)	26/4	26/4	26/4
Age (years)	42.3 ± 9.8 (46)	42.9 ± 7.4 (44)	42.3 ± 8.9 (40)	0.69
Height (cm)	160.8 ± 7.2 (160)	160.2 ± 6.4 (160)	161.7 ± 7.4 (160)	0.53
Weight (kg)	75.9 ± 14.8 (74.8)	75.3 ± 15.7 (71.5)	77.9 ± 16.2 (75.2)	0.79
BMI (kg/cm²)	29.9 ± 6.6 (28.4)	29.9 ± 6.5 (30.2)	29.4 ± 5.5 (29.2)	0.93
FFM (kg)	44.7 ± 10.6 (44.6)	37.6 ± 14.4 (38.5)	36.3 ± 14.3 (37.5)	0.01*

↓ Table 1. Demographic Characteristics of Groups

Control (n = 30) (mean ± SD)

HypoT (n = 30) (mean ± SD)

HypoPT + T (n = 30) (mean ± SD)

*Statistically significant differences (P < 0.05). BMI: body mass index; FFM: fat-free mass; HypoT: postsurgical hypothyroidism; HypoPT + T: postsurgical hypoparathyroidism and hypothyroidism; SD: standard deviation.

Gender (female/male)

26/4

Age (years)

42.3 ± 9.8 (46)

42.9 ± 7.4 (44)

42.3 ± 8.9 (40)

0.69

Height (cm)

160.8 ± 7.2 (160)

160.2 ± 6.4 (160)

161.7 ± 7.4 (160)

0.53

Weight (kg)

75.9 ± 14.8 (74.8)

75.3 ± 15.7 (71.5)

77.9 ± 16.2 (75.2)

0.79

BMI (kg/cm²)

29.9 ± 6.6 (28.4)

29.9 ± 6.5 (30.2)

29.4 ± 5.5 (29.2)

0.93

FFM (kg)

44.7 ± 10.6 (44.6)

37.6 ± 14.4 (38.5)

36.3 ± 14.3 (37.5)

0.01*

↓ **Table 2.** Comparison of Thyroid Surgery Type, Time After Surgery, Diseases Necessitating Surgery of Groups
	Control (n = 30)	HypoT (n = 30)	HypoPT + T (n = 30)	P
Values are n (%) or mean. HypoT: postsurgical hypothyroidism; HypoPT + T: postsurgical hypoparathyroidism and hypothyroidism.
Surgery type				0.09
Total	-	22	27
Subtotal	-	8	3
Time since surgery (years)	-	9	8.1	0.51
Diseases necessitating surgery
Multinodular goiter	-	23	22
Diffuse goiter	-	2	3
Graves	-	5	5
Medical treatments
Levothyroxine, n (%)	-	30 (100)	30 (100)
Dose (µg/day)		129 (50–200)	120.8 (25–225)	0.68
Alfacalcidiol, n (%)	-	-	30 (100)
Dose (µg/day)			0.8 (0.25–2)
Use of calcium supplement, n (%)	-	-	30 (100)
Dose (mg/day)	-	-	600 (600–1,800)
Use of vitamin D3 supplement, n (%)	-	-	7 (23)
Dose (IU/day)	-	-	800 (800–1,600)

↓ Table 2. Comparison of Thyroid Surgery Type, Time After Surgery, Diseases Necessitating Surgery of Groups

Control (n = 30)

HypoT (n = 30)

HypoPT + T (n = 30)

Values are n (%) or mean. HypoT: postsurgical hypothyroidism; HypoPT + T: postsurgical hypoparathyroidism and hypothyroidism.

Surgery type

0.09

Total

Subtotal

Time since surgery (years)

8.1

0.51

Diseases necessitating surgery

Multinodular goiter

Diffuse goiter

Graves

Medical treatments

Levothyroxine, n (%)

30 (100)

Dose (µg/day)

129 (50–200)

120.8 (25–225)

0.68

Alfacalcidiol, n (%)

30 (100)

Dose (µg/day)

0.8 (0.25–2)

Use of calcium supplement, n (%)

30 (100)

Dose (mg/day)

600 (600–1,800)

Use of vitamin D3 supplement, n (%)

7 (23)

Dose (IU/day)

800 (800–1,600)

↓ **Table 3.** Biochemical Evaluation of the Participants
	Reference	Control (n = 30)	HypoT (n = 30)	HypoPT + T (n = 30)	P
Values are mean ± SD. *Statistically significant differences (P < 0.05).CK: creatinin kinase; eGFR: estimated glomerular filtration rate; HypoT: postsurgical hypothyroidism; HypoPT + T: postsurgical hypoparathyroidism and hypothyroidism; PTH: parathyroid hormone; ST4: free T4; TSH: thyroid-stimulating hormone.
TSH (mIU/L)	0.40–3.77	2.1 ± 1	2.3 ± 1.4	1.8 ± 1.5	0.15
ST4 (ng/dL)	0.93–1.6	1.2 ± 0.1	1.3 ± 0.2	1.4 ± 0.2	0.11
Calcium (mg/dL)	8.8–10.6	9 ± 0.4	9.1 ± 0.5	8.8 ± 0.5	0.05
Phosphate (mg/dL)	2.6–4.5	3.5 ± 0.3	3.5 ± 0.5	3.7 ± 0.6	0.11
Magnesium (mmol/L)	0.66–1.07	0.83 ± 0.06	0.84 ± 0.05	0.83 ± 0.04	0.18
Creatinine (mg/dL)	< 0.90	0.76 ± 0.1	0.74 ± 0.1	0.70 ± 0.1	0.11
eGFR (mL/min/1.73 m²)	≥ 90	103 ± 23	95.8 ± 13.4	97 ± 16.8	0.11
PTH (ng/mL)	15–65	39.9 ± 11.4	42.2 ± 11.5	15.5 ± 7.7	0.0*
25OHVitD	30–80	33.3 ± 3.5	33.7 ± 2.8	34.6 ± 4.1	0.37
CK (U/L)	< 170	78.3 ± 41.8	116.5 ± 62.6	119.4 ± 57.2	0.0*

↓ Table 3. Biochemical Evaluation of the Participants

Reference

Control (n = 30)

HypoT (n = 30)

HypoPT + T (n = 30)

Values are mean ± SD. *Statistically significant differences (P < 0.05).CK: creatinin kinase; eGFR: estimated glomerular filtration rate; HypoT: postsurgical hypothyroidism; HypoPT + T: postsurgical hypoparathyroidism and hypothyroidism; PTH: parathyroid hormone; ST4: free T4; TSH: thyroid-stimulating hormone.

TSH (mIU/L)

0.40–3.77

2.1 ± 1

2.3 ± 1.4

1.8 ± 1.5

0.15

ST4 (ng/dL)

0.93–1.6

1.2 ± 0.1

1.3 ± 0.2

1.4 ± 0.2

0.11

Calcium (mg/dL)

8.8–10.6

9 ± 0.4

9.1 ± 0.5

8.8 ± 0.5

0.05

Phosphate (mg/dL)

2.6–4.5

3.5 ± 0.3

3.5 ± 0.5

3.7 ± 0.6

0.11

Magnesium (mmol/L)

0.66–1.07

0.83 ± 0.06

0.84 ± 0.05

0.83 ± 0.04

0.18

Creatinine (mg/dL)

< 0.90

0.76 ± 0.1

0.74 ± 0.1

0.70 ± 0.1

0.11

eGFR (mL/min/1.73 m²)

≥ 90

103 ± 23

95.8 ± 13.4

97 ± 16.8

0.11

PTH (ng/mL)

15–65

39.9 ± 11.4

42.2 ± 11.5

15.5 ± 7.7

0.0*

25OHVitD

30–80

33.3 ± 3.5

33.7 ± 2.8

34.6 ± 4.1

0.37

CK (U/L)

< 170

78.3 ± 41.8

116.5 ± 62.6

119.4 ± 57.2

0.0*

↓ **Table 4.** Concentric Isokinetic Muscle Strength Measurements Assessed by BIODEX Dynamometry
	Control (n = 30)	HypoT (n = 30)	HypoPT + T (n = 30)	P
Values are mean ± SD. HypoT: postsurgical hypothyroidism; HypoPT + T: postsurgical hypoparathyroidism and hypothyroidism.
Pinch grip strength (kg)	4.2 ± 0.9	4.2 ± 0.9	4.1 ± 0.9	0.94
Lateral grip strength (kg)	6.6 ± 1.5	6.2 ± 1.8	6.1 ± 1	0.38
Triple grip strength (kg)	5.3 ± 1.3	5.3 ± 1.5	5.2 ± 1.6	0.97
Hand wrist grip strength (kg)	26.1 ± 4.6	26.5 ± 4.3	25 ± 6.7	0.54
60°/s extension lower extremite peak tork (Nm)	87 ± 24.8	85.7 ± 14.6	84.6 ± 23	0.97
60°/s flexion lower extremite peak tork (Nm)	57.5 ± 16.7	58.3 ± 11.7	54.9 ± 20.1	0.46
120°/s extension lower extremite peak tork (Nm)	61.1 ± 22.5	55.6 ± 11.4	53.5 ± 13.3	0.19
120°/s flexion lower extremite peak tork (Nm)	44.5 ± 18.2	45.9 ± 9	40.6 ± 14.5	0.33
180°/s extension lower extremite peak tork (Nm)	45.4 ± 17	44 ± 10.6	40.5 ± 11	0.35
180°/s flexion lower extremite peak tork (Nm)	37.1 ± 14.3	36.9 ± 7.7	33.5 ± 12.5	0.28

↓ Table 4. Concentric Isokinetic Muscle Strength Measurements Assessed by BIODEX Dynamometry

Control (n = 30)

HypoT (n = 30)

HypoPT + T (n = 30)

Values are mean ± SD. HypoT: postsurgical hypothyroidism; HypoPT + T: postsurgical hypoparathyroidism and hypothyroidism.

Pinch grip strength (kg)

4.2 ± 0.9

4.1 ± 0.9

0.94

Lateral grip strength (kg)

6.6 ± 1.5

6.2 ± 1.8

6.1 ± 1

0.38

Triple grip strength (kg)

5.3 ± 1.3

5.3 ± 1.5

5.2 ± 1.6

0.97

Hand wrist grip strength (kg)

26.1 ± 4.6

26.5 ± 4.3

25 ± 6.7

0.54

60°/s extension lower extremite peak tork (Nm)

87 ± 24.8

85.7 ± 14.6

84.6 ± 23

0.97

60°/s flexion lower extremite peak tork (Nm)

57.5 ± 16.7

58.3 ± 11.7

54.9 ± 20.1

0.46

120°/s extension lower extremite peak tork (Nm)

61.1 ± 22.5

55.6 ± 11.4

53.5 ± 13.3

0.19

120°/s flexion lower extremite peak tork (Nm)

44.5 ± 18.2

45.9 ± 9

40.6 ± 14.5

0.33

180°/s extension lower extremite peak tork (Nm)

45.4 ± 17

44 ± 10.6

40.5 ± 11

0.35

180°/s flexion lower extremite peak tork (Nm)

37.1 ± 14.3

36.9 ± 7.7

33.5 ± 12.5

0.28

↓ **Table 5.** TUG and RCS Test Results
	Control (n = 30)	HypoT (n = 30)	HypoPT + T (n = 30)	P
Values are mean ± SD. *Statistically significant differences (P < 0.05). HypoT: postsurgical hypothyroidism; HypoPT + T: postsurgical hypoparathyroidism and hypothyroidism. RCS: repeated chair stands; TUG: timed up and go.
RCS	11.7 ± 1.6	11 ± 2	9.9 ± 2	0.001*
TUG (s)	12.9 ± 1	15 ± 1.8	14.7 ± 2.2	0.0*

↓ Table 5. TUG and RCS Test Results

Control (n = 30)

HypoT (n = 30)

HypoPT + T (n = 30)

Values are mean ± SD. *Statistically significant differences (P < 0.05). HypoT: postsurgical hypothyroidism; HypoPT + T: postsurgical hypoparathyroidism and hypothyroidism. RCS: repeated chair stands; TUG: timed up and go.

RCS

11.7 ± 1.6

11 ± 2

9.9 ± 2

0.001*

TUG (s)

12.9 ± 1

15 ± 1.8

14.7 ± 2.2

0.0*