Proton Pump Inhibitors Linked to Increased Risk of Hypocalcemia After Thyroid Surgery, suggests study

A new study published in the journal of Laryngoscope Investigative Otolaryngology revealed that patients using proton pump inhibitors (PPIs) may have a higher likelihood of developing both short-term and permanent hypocalcemia following thyroidectomy. This largest study to date confirms a significant association between PPI use and increased risk of post-thyroidectomy hypocalcemia.

One of the most frequent surgical procedures is thyroidectomies. The only effective treatment for thyroid cancers and benign conditions like multinodular goiter with compressive symptoms is thyroid surgery. One recognized side effect of thyroidectomy is hypocalcemia. Thyroidectomy patients run the danger of devascularization or unintentional parathyroid gland avulsion.

The incidence of both temporary and permanent postoperative hypoparathyroidism varies from 0.3% to 49% and 0% to 13%, respectively, according to the literature. PPIs, or proton pump inhibitors, are frequently prescribed drugs. They make up about 5–10% of all prescriptions, and their usage is still growing. PPIs are recommended for a number of common conditions, including Barrett's esophagus, Helicobacter pylori infection, gastric and duodenal ulcers, and gastroesophageal reflux disease (GERD).

According to a previous study, individuals on PPIs had a markedly higher risk of both temporary and persistent hypocalcemia following parathyroidectomy. Thus, this study was to ascertain the prevalence of hypocalcemia in individuals on proton pump inhibitors after thyroidectomy.

The TriNetX Research Network was used to identify patients who had complete thyroidectomies between 2012 and 2022. The patients with and without prescriptions for proton pump inhibitors were compared in terms of the incidence of temporary hypocalcemia (0–6 months after thyroidectomy) and permanent hypocalcemia (6–12 months after thyroidectomy).

Prior to surgery, 21.3% (n = 7081) of the 33,309 patients received proton pump inhibitors. Hypocalcemia occurred in 50.9% and 10.76% of thyroidectomy patients on proton pump inhibitors at 0–1 and 6–12 months, respectively, compared to 48.3% and 7.22% of patients not on proton pump inhibitors. Hypocalcemia at 0–1, 1–6, and 6–12 months was much more likely to occur in patients on proton pump inhibitors. Additionally, patients on proton pump inhibitors had a higher chance of going to the ED 1 to 6 months after surgery.

Overall, after a thyroidectomy, hypocalcemia is frequently transient and goes away for most people. This researchers discovered that PPI users may be more susceptible to both temporary and long-term hypocalcemia. To definitively ascertain if using PPIs lowers the risk of coming to the emergency department after surgery and brings the risk of hypocalcemia back to baseline, more research is required.

Source:

Rossip, M., Lorenz, F. J., Goyal, N., & Goldenberg, D. (2025). Hypocalcemia after thyroidectomy in patients taking proton pump inhibitors. Laryngoscope Investigative Otolaryngology, 10(3), e70163. https://doi.org/10.1002/lio2.70163