Prospective study of postoperative hypocalcemia after total thyroidectomy
Keywords:
Hypocalcemia, Hypoparathyroidism, Total Thyroidectomy
Abstract
Background: Postoperative hypocalcemia is a common complication following total thyroidectomy. Various risk factors lead to damage of parathyroid gland or its blood supply or accidental removal of gland. Early identification and supplementation with calcium and Vitamin D reduces the severity of symptoms and morbidity to the patients.
Aim: The study aims to identify the incidence of hypocalcemia in patients undergoing total thyroidectomy.
Materials and Methods: Prospective analysis was made in 50 patients undergoing total thyroidectomy for benign thyroid disorders, to identify the incidence of hypocalcemia by measuring Serum calcium levels postoperatively at 24 hours, on day 3, day 14 and after 6 months.
Results: Incidence of 22% of hypocalcemia, with transient hypocalcemia in 20% and permanent hypocalcemia in 2% of cases were noted.
Conclusion: Meticulous surgical technique to preserve parathyroid gland, early identification of hypocalcemia, with adequate supplementation with calcium and vitamin D reduces the morbidity in patients undergoing total thyroidectomy.
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References
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18. Pesce CE, Shiue Z, Tsai HL, et al. Postoperative hypocalcemia after thyroidectomy for Graves' disease. Thyroid. 2010 Nov;20(11):1279-83. doi: 10.1089/thy.2010.0047. Epub 2010 Oct 18.[pubmed]
19. Ritter K, Elfenbein D, Schneider DF, et al. Hypoparathyroidism after total thyroidectomy: incidence and resolution. J Surg Res. 2015 Aug;197(2):348-53. doi: 10.1016/j.jss.2015.04.059. Epub 2015 Apr 21.
20. Cooper MS, Gittoes NJ. Diagnosis and management of hypocalcaemia. BMJ. 2008 Jun 7;336(7656):1298-302. doi: 10.1136/bmj.39582.589433.BE.[pubmed]
21. Welch KC, McHenry CR. Total thyroidectomy: is morbidity higher for Graves' disease than nontoxic goiter? J Surg Res. 2011 Sep;170(1):96-9. doi: 10.1016/j.jss.2011.03.054. Epub 2011 Apr 19.[pubmed]
22. Nahas ZS, Farrag TY, Lin FR, et al. A safe and cost-effective short hospital stay protocol to identify patients at low risk for the development of significant hypocalcemia after total thyroidectomy. Laryngoscope. 2006 Jun;116(6):906-10. DOI:10.1097/01.mlg.0000217536.83395.37
23. Tredici P, Grosso E, Gibelli B, et al. Identification of patients at high risk for hypocalcemia after total thyroidectomy. Acta Otorhinolaryngol Ital. 2011 Jun;31(3):144-8.[pubmed]
2. Asari R, Passler C, Kaczirek K, et al. Hypoparathyroidism after total thyroidectomy: a prospective study. Arch Surg. 2008 Feb;143(2):132-7; discussion 138. doi: 10.1001/archsurg.2007.55.[pubmed]
3. Abboud B, Sargi Z, Akkam M, et al. Risk factors for post thyroidectomy hypocalcemia. J Am Coll Surg. 2002 Oct;195(4):456-61.[pubmed]
4. Thomusch O, Machens A, Sekulla C, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg. 2000 Nov;24(11):1335-41.[pubmed]
5. McHenry CR, Speroff T, Wentworth D, et al. Risk factors for post thyroidectomy hypocalcemia. Surgery. 1994 Oct;116(4):641-7; discussion 647-8.[pubmed]
6. Bellantone R, Lombardi CP, Raffaelli M, et al. Is routine supplementation therapy (calcium and vitamin D) useful after total thyroidectomy? Surgery. 2002 Dec;132(6):1109-12; discussion 1112-3. DOI:10.1067/msy.2002.128617.[pubmed]
7. Roh JL, Park CI. Routine oral calcium and vitamin D supplements for prevention of hypocalcemia after total thyroidectomy. Am J Surg. 2006 Nov;192(5):675-8. DOI:10.1016/j.amjsurg.2006.03.010.[pubmed]
8. Ozogul B, Akcay MN, Akcay G, et al. Factors affecting hypocalcaemia following total thyroidectomy: a prospective study. Eurasian J Med. 2014 Feb;46(1):15-21. doi: 10.5152/eajm.2014.03.
9. Ozemir IA, Buldanli MZ, Yener O, et al. Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy. North Clin Istanb. 2016 Apr 7;3(1):9-14. doi: 10.14744/nci.2016.48802. eCollection 2016.[pubmed]
10. Noureldine SI, Genther DJ, Lopez M, et al. Early predictors of hypocalcemia after total thyroidectomy: an analysis of 304 patients using a short-stay monitoring protocol. JAMA Otolaryngol Head Neck Surg. 2014 Nov;140(11):1006-13. doi: 10.1001/jamaoto.2014.2435.[pubmed]
11. R. S. Sippel, O. Ozgul, G. K. Hartig, E. A.Mack, andH. Chen. Risks and consequences of incidental parathyroidectomy during thyroid resection. ANZ Journal of Surgery, vol. 77, no. 1-2, pp. 33–36, 2007.
12. G. R. Qasaimeh, S. Al Nemri, and A. K. Al Omari. Incidental extirpation of the parathyroid glands at thyroid surgery: risk factors and post-operative hypocalcemia. European Archives of Oto-Rhino-Laryngology, vol. 268, no. 7, pp. 1047–1051, 2011.[pubmed]
13. Paek SH, Lee YM, Min SY, et al. Risk factors of hypoparathyroidism following total thyroidectomy for thyroid cancer. World J Surg. 2013 Jan;37(1):94-101. doi: 10.1007/s00268-012-1809-4.[pubmed]
14. Erbil Y, Barbaros U, Temel B, et al. The impact of age, vitamin D(3) level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy. Am J Surg. 2009 Apr;197(4):439-46. doi: 10.1016/j.amjsurg.2008.01.032.[pubmed]
15. Salvatore Tolone, Ruggiero Roberto, Gianmattia del Genio, Luigi Brusciano, Domenico Parmeggiani, Vincenzo Amoroso, Giuseppina Casalino, Ignazio Verde, Alfonso Bosco, Antonio D’Alessandro, Raffaele Pirozzi, Gianluca Rossetti, Paolo Limongelli, Ludovico Docimo : The impact of age and oral calcium and vitamin D supplements on postoperative hypocalcemia after total thyroidectomy. A prospective study. BMC Surg 2013;13 Suppl 2:S11. doi: 10.1186/1471-2482-13-S2-S11.
16. Wingert DJ, Friesen SR, Iliopoulos JI, et al. Post-thyroidectomy hypocalcemia. Incidence and risk factors. Am J Surg. 1986 Dec;152(6):606-10.[pubmed]
17. Kalyoncu D, Gonullu D, Gedik ML, Er M, Kuroglu E, Igdem AA and Koksoy FN: Analysis of the factors that have an effect on hypocalcemia following thyroidectomy. Ulus Cerrahi Derg 29: 171-176, 2013.
18. Pesce CE, Shiue Z, Tsai HL, et al. Postoperative hypocalcemia after thyroidectomy for Graves' disease. Thyroid. 2010 Nov;20(11):1279-83. doi: 10.1089/thy.2010.0047. Epub 2010 Oct 18.[pubmed]
19. Ritter K, Elfenbein D, Schneider DF, et al. Hypoparathyroidism after total thyroidectomy: incidence and resolution. J Surg Res. 2015 Aug;197(2):348-53. doi: 10.1016/j.jss.2015.04.059. Epub 2015 Apr 21.
20. Cooper MS, Gittoes NJ. Diagnosis and management of hypocalcaemia. BMJ. 2008 Jun 7;336(7656):1298-302. doi: 10.1136/bmj.39582.589433.BE.[pubmed]
21. Welch KC, McHenry CR. Total thyroidectomy: is morbidity higher for Graves' disease than nontoxic goiter? J Surg Res. 2011 Sep;170(1):96-9. doi: 10.1016/j.jss.2011.03.054. Epub 2011 Apr 19.[pubmed]
22. Nahas ZS, Farrag TY, Lin FR, et al. A safe and cost-effective short hospital stay protocol to identify patients at low risk for the development of significant hypocalcemia after total thyroidectomy. Laryngoscope. 2006 Jun;116(6):906-10. DOI:10.1097/01.mlg.0000217536.83395.37
23. Tredici P, Grosso E, Gibelli B, et al. Identification of patients at high risk for hypocalcemia after total thyroidectomy. Acta Otorhinolaryngol Ital. 2011 Jun;31(3):144-8.[pubmed]
CITATION
DOI: 10.17511/ijoso.2019.i02.10
Published: 2019-06-30
How to Cite
S., V., S R., K., B Kulkarni, S., & Hanumanthaiah, K. (2019). Prospective study of postoperative hypocalcemia after total thyroidectomy. Surgical Review: International Journal of Surgery, Trauma and Orthopedics, 5(2), 121-125. https://doi.org/10.17511/ijoso.2019.i02.10
Section
Original Article
OAI - Open Archives Initiative
Therapoid
