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The most common cause of hypoparathyroidism is accidental excision during thyroidectomy. This surgical procedure often involves the removal of the thyroid gland, which is located in close proximity to the parathyroid glands. During a thyroidectomy, especially if performed for conditions such as thyroid cancer or hyperthyroidism, there is a risk that the parathyroid glands may be harmed or removed inadvertently. The subsequent loss or damage to these glands leads to a decrease in parathyroid hormone production, resulting in hypoparathyroidism.

While autoimmune disorders can lead to various endocrine issues, they are not the primary cause of hypoparathyroidism. Genetic mutations are also associated with certain syndromes that can affect parathyroid function, but they do not occur as frequently in the general population when compared to surgical complications. Radiation exposure can impact parathyroid function, however, this scenario is less common than procedural accidents resulting from thyroid surgery. Thus, accidental excision during thyroidectomy stands out as the leading cause of hypoparathyroidism.