(lymph node dissection) □ Yes □ No 2

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Supplemental Digital Content 1. Medical questionnaire (translated from French)

Post-thyroidectomy hyperparathyroidism questionnaire (translated from French)

Your initials (first name – last name): ………….. - ……….

Your year of birth: ……….

Your sex:

□

^Male

□

^Female

Your ethic group (this will be used to calculate your kidney function):

□

Afro-American or Sub-Saharian African origin

□

^Other

Date of your thyroid surgery: ………/………/………

1. You had a total thyroidectomy. In complement, were lymph nodes removed? (lymph node dissection)

□

^Yes

□

^No

2. The histopathologic analysis of the thyroid showed:

□

A non-cancerous lesion

□

A thyroid cancer If it was a cancer:

- What was its type?

□

Medullar carcinoma

□

Papillary carcinoma

□

Follicular carcinoma

□

Other: ___________

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- What was its size? _______ cm

- Did you benefit from a ¹³¹I therapy (or iodine radiotherapy or iodo-therapy)?

□

^Yes

□

^No

- Did you have an external radiotherapy treatment?

□

^Yes

□

^No

3. If it was not a cancer, do you remember the thyroid disease having led to thyroidectomy? (Goiter with normal thyroid function? Grave’s disease? Other?)

4. Today, do you think your voice is normal?

□

^Yes

□

^No

5. Did you have a vocal cord examination after your operation?

□

^Yes^

□

It was normal

□

It was not normal

□

^No

6. Since your operation, you are taking a hormone therapy treatment. What is its name and at what daily dose is currently prescribed?

□

^Lévothyrox^®……….. Dose: ……….µg per day

□

L-Thyroxine SERB®……….……….. Dose: ……….µg per day

□

^Euthyrox^®……….………….. Dose: ……….µg per day

□

Other (precise): ………..………….……….. Dose: ……….µg per day 7. Since your operation, have you received one or more of the following treatments acting on calcemia?

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Treatment Dose (per day) Year of the first prescription Are you taking it now?

□

^Calcidia^® ^………

.

………..

.

□

^Yes

□

No- date of the last prescription …/…/…

□

^Calcidose^® (+/- vitamin D3)

………

.

………..

.

□

^Yes

□

Calciforte® ^………

.

………..

.

□

^Yes

□

^Calciprat^® (+/- vitamin D3) ………

.

………..

.

□

^Yes

□

^Uvedose^® ^………

.

………..

.

□

^Yes

□

^Dedrogyl^® (calciferol) ………

.

………..

.

□

^Yes

□

^Rocaltol^® (calcitriol) ………

.

………..

.

□

^Yes

□

^Un-Alfa^® ^………

.

………..

.

□

^Yes

□

^Forsteo^® (teriparatide) ………

.

………..

.

□

^Yes

□

8. Since your operation, have you regularly felt tingling (paresthesia)?

□

^Yes

□

^No

9. Since your operation, have you experienced abnormal (involuntary) movements of the body or limbs?

□

^Yes

□

^No

10. Since your operation, have you experienced a tetany crisis (stiffening of the members or hands)?

□

^Yes

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□

^No

11. Since your operation, have you experienced an epileptic crisis requiring a specific treatment prescribed by a neurologist?

□

^Yes

□

^No

□

Yes, but I had already had epileptic crises before the operation

12. Since your operation, have you had a kidney imagery exam (radiography or echography) that found renal calculi or lithiasis?

□

^Yes

□

^No

13. Since your operation, have you presented cardiovascular problems (infarction, stroke…)?

□

Yes – please specify: ____________

□

^No

14. Since your operation, have you had a cardiac examination (electrocardiography) which found cardiac rhythm disturbance?

□

^Yes

□

^No

15. Since your operation, have you had muscular pain or cramps?

□

^Never

□

^Sometimes

□

^Often

□

^Very-often

16. Since your operation, have you experienced anxiety attacks?

□

^Yes

□

^No

17. Since your operation, have you had nausea?

□

^Never

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□

^Sometimes

□

^Often

□

^Very-often

18. Since your operation, have you had tinnitus?

□

^Yes

□

^No

19. Since your operation, have you developed cataracts?

□

^Yes

□

^No

20. Since your operation, have you experienced memory loss?

□

^Never

□

^Sometimes

□

^Often

□

^Very-often

21. Since your operation, have you experienced difficulties of concentration?

□

^Never

□

^Sometimes

□

^Often

□

^Very-often

22. Since your operation, have you felt depressive humor?

□

^Never

□

^Sometimes

□

^Often

□

^Very-often

23. Since your operation, have you had joint pain?

□

^Yes

□

^No

24. Since your operation, have you been easily irritable?

□

^Never

□

^Sometimes

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□

^Often

□

^Very-often

25. Since your operation, have you experienced episodes of intense exhaustion?

□

^Yes

□

^No

26. In the blood samples taken more than 6 months after your operation, can you please indicate the results of the following dosages (if available):

Dosage Results Unit

TSH ………

. mUI/L

Calcium ………

.

□

mmol/L or

□

^mg/L

PTH (parathormone) ………

. pg/mL

27. In the last blood sample, can you please indicate the results of the following dosages:

Dosage Results Unit

TSH ………

. mUI/L

Calcium ………

.

□

mmol/L or

□

^mg/L

PTH (parathormone) ………

. pg/mL

28. Today, do you present a chronic disease other than hypoparathyroidism (ex: cutaneous, digestive tract, neurologic, kidney, bone, inflammatory chronic disease) ?

29. Are you or have you already been followed for a cancerous disease (whoever it is/was)? If yes, please precise.

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Supplemental Digital Content 3. Uni- and multivariate analyses using zero-inflated Poisson regression. Relation between VHI and potential confounding factors taking into account results of vocal cord examination

Univariable analysis Multivariable analysis

Coefficient [95%CI] p-value Coefficient [95%CI]

HypoPT 1.83 [1.91–2.07] <0.001 12.74 [5.30–30.61]

Female sex 0.68 [0.59–0.79] <0.001 3.16 [1.41–7.11]

Age £ 1.10 [1.05–1.16] <0.001 1.22 [1.00–1.50]

Thyroid cancer 1.00 [0.84–1.18] 0.492 0.17 [0.05–0.55]

Abnormal vocal cord mobility § 3.30 [2.59–4.20] <0.001 0.61 [0.24–1.53]

Abnormal TSH level† 0.78 [0.64–0.97] 0.022 8.99 [2.10–38.51]

Legends: HypoPT, hypoparathyroidism; 95%CI, 95% confidence interval

£ In 10-year increments

§ Abnormal vocal cord mobility diagnosed with laryngoscopy (n = 41 patients)

† Normal TSH level between 0.2 and 4.0 mUI/mL