Impact of preoperative thyroid antibody levels on parathyroid outcomes in thyroidectomy: The role of a standardized parathyroid-preserving strategy.

OBJECTIVE: Postoperative hypoparathyroidism (hypoPT) remains a significant complication after total thyroidectomy. Elevated thyroid autoantibodies are commonly considered surrogate markers of autoimmune thyroiditis and are presumed to increase surgical difficulty, potentially leading to parathyroid injury; however, their independent impact on postoperative parathyroid outcomes remain uncertain. This study aimed to evaluate the association between elevated preoperative thyroid antibody levels and postoperative parathyroid dysfunction in patients undergoing total thyroidectomy. METHODS: This retrospective study analyzed adult patients who underwent standardized monitored total thyroidectomy using energy-based devices at a tertiary referral center between January 2021 and January 2024. Preoperative anti-thyroglobulin antibody (TgAb) and thyroid microsomal antibody (TMAb) levels were classified as normal or elevated. Parathyroid outcomes were compared between groups, and multivariable logistic regression analysis was performed to evaluate the independent association between elevated thyroid antibody levels and postoperative hypoPT. A standardized parathyroid-preserving surgical protocol was used in all cases. RESULTS: Among 145 patients, 62 (42.8%) had elevated thyroid antibody levels. No significant differences were observed between normal and elevated antibody groups in lowest postoperative iPTH, postoperative hypoPT, or pathological identification of parathyroid glands. Multivariable logistic regression analysis further showed no statistically significant association between elevated thyroid antibody levels and postoperative hypoPT. CONCLUSION: Elevated TgAb or TMAb alone was not significantly associated with postoperative hypoPT. Thyroid antibody levels may not be a reliable surrogate for predicting postoperative parathyroid outcomes. These findings should be interpreted within the context of a standardized parathyroid-preserving strategy.