A Prophylactic Infusion of Calcium Solution Reduces the Risk of Symptomatic Hypocalcemia in Patients after Total Thyroidectomy

Uruno, Takashi; Miyauchi, Akira; Shimizu, Kazuo; Tomoda, Chisato; Takamura, Yuuki; Ito, Yasuhiro; Miya, Akihiro; Kobayashi, Kaoru; Matsuzuka, Fumio; Amino, Nobuyuki; Kuma, Kanji

doi:10.1007/s00268-005-0374-5

Cited by 35 publications

(29 citation statements)

References 22 publications

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“…Although a single functioning parathyroid is reported to be sufficient for maintenance of calcium balance, publications stating that at least two of the glands should be removed to result in temporary or permanent hypoparathyroidism due to incidental parathyroidectomy are also present (16,29,30). In our study, the rate of incidental parathyroidectomy was found to be 10.5%.…”

Section: Discussionsupporting

confidence: 51%

Analysis of the factors that have an effect on hypocalcemia following thyroidectomy

Kalyoncu¹,

Gönüllü²,

Gedik³

et al. 2014

UCD

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Objective: The incidence of and risk factors for hypocalcemia following thyroidectomy were evaluated in this study. Material and Methods:One hundred and ninety thyroidectomy patients were evaluated retrospectively for factors that might contribute to postoperative hypocalcemia; age, hyperthyroidism, malignancy, the extent of surgery (total/near total/subtotal thyroidectomy), cervical lymph node dissection, and incidental parathyroidectomy. Results:The rate of transient hypocalcemia/hypoparathyroidism was 19.47%, with a permanent hypoparathyroidism rate of 4.74%. Factors affecting the development of transient hypocalcemia were found as being operated for hyperthyroidism, and use of total thyroidectomy as the surgical method. Total thyroidectomy increased the risk of postoperative hypocalcemia by 3.16 fold. Patients undergoing operations for hyperthyroidism had a 2.3 fold increase, and those undergoing total thyroidectomy had a 3.16 fold risk of postoperative hypocalcemia. Conclusion:Hyperthyroidism surgery and total thyroidectomy lead to a higher risk of developing early postoperative or transient hypocalcemia. According to our results, no significant relationship could be established between any of the study parameters and persistent hypocalcemia.

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Section: Discussionsupporting

confidence: 51%

Analysis of the factors that have an effect on hypocalcemia following thyroidectomy

Kalyoncu¹,

Gönüllü²,

Gedik³

et al. 2014

UCD

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“…In 40-50% of such cases, it has been found that the parathyroid gland was located within the thyroid gland (12). It is usually reported that at least two glands should be injured for hypoparathyroidism to develop (13,14).…”

Section: Discussionmentioning

confidence: 99%

The risk of hypocalcemia in patients with parathyroid autotransplantation during thyroidectomy

Oran

Yetkın

Mihmanlı

et al. 2016

UCD

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Objective: Thyroidectomy is the most common cause of hypocalcemia. Preservation of parathyroid glands in situ is essential in preventing this complication. The aims of our study were to review patients who underwent parathyroid gland autotransplantation during thyroidectomy, and to compare hypocalcemia rates in patients with and without autotransplantation. Material and Methods:Parathyroid gland autotransplantation was performed in 43 (7.9%) of 543 patients who underwent thyroidectomy between 2008 and 2012.Results: Forty-four parathyroid glands were autotransplanted in 43 patients, including 36 women and 7 men. The median age was 55 (range: 30 to 68). The most common cause of autotransplantation was vascular comprise of the parathyroid gland. Early postoperative hypocalcemia developed in 37% of patients with autotransplantation, and none developed permanent hypocalcemia. Transient and permanent hypocalcemia rates were 9.6% and 0.4% in patients without autotransplantation, respectively. The risk of transient hypocalcemia was significantly high in patients with parathyroid autotransplantation (p<0.001). There was no difference between the two groups in terms of permanent hypocalcemia (p=0.156). Conclusion:Despite meticulous dissection, parathyroid glands can be devascularized or removed inadvertently during thyroidectomy. Parathyroid autotransplantation is the best method to maintain parathyroid gland function. Although the risk of transient hypocalcemia is increased following parathyroid autotransplantation, long-term results are satisfactory. INTRODUCTIONThyroid surgery is the most frequently performed operation in general surgery clinics, and constitute 1% of all medical diseases (1). The second most feared complication of thyroid surgery, following recurrent laryngeal nerve (RLN) injury, is the development of hypocalcemia. The most common cause of hypocalcemia is post-surgery hypoparathyroidism (2). Hypocalcemia may develop in the immediate postoperative period and may improve in several weeks (transient hypocalcemia), or it may persist for more than 6 months after surgery, in which case is called permanent hypocalcemia. Hypocalcemia manifests with paresthesia, mental status changes, neuromuscular irritability, and muscle spasm. Chronic hypocalcemia can lead to cataract formation, calcification in the cerebellum and basal ganglia, peripheral neuropathy, and cardiac problems. These patients require lifelong calcium and vitamin D supplements.

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“…6 In a study by Uruno et al, calcium solution infusion was found to be beneficial in preventing the development of symptomatic hypocalcaemia thereby reducing patient distress,however no patients required intravenous calcium for symptomatic hypocalcaemia in the present study. 7 Oral administration of 1 µg of calcitriol twice per day and 500 mg of calcium salts 3 times per day after total thyroidectomy significantly decreased the risk of severe postoperative hypocalcemia. 8 These studies suggest that post thyroidectomy hypocalcaemia can be considerably prevented by the routine prophylactic administration of calcium and vitamin D supplements.…”

Section: Discussionmentioning

confidence: 99%

A prospective study to determine the role of routine prophylactic oral calcium and vitamin D supplements in prevention of transient hypocalcaemia after total and near total thyroidectomy

2017

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Background: Transient hypocalcaemia is a frequent complication after total thyroidectomy, and the symptoms are very distressing for the patients. This study is a prospective cohort study to assess the effectiveness of routine postoperative oral calcium and vitamin D supplementation in post thyroidectomy hypocalcaemia.Methods: 135 patients undergoing near total or total thyroidectomy were divided into two groups, exposed and unexposed, based on post-operative calcium and Vitamin D administration. Both groups were followed up at day 3, at discharge and 2 weeks post operatively for the development of hypocalcaemia.Results: Common age group was 31-40 years in both groups. The mean corrected pre-operative serum calcium was 9.06±0.43mg/dl for the exposed and 9.2±0.62mg/dl for the unexposed group (p = 0.12). The mean corrected calcium levels, on third post op day was 8.9±0.61mg/dl for exposed and 8.5±0.69mg/dl for unexposed group p = 0.001), on day of discharge was 9.2±0.56mg/dl for exposed and 9.0±0.48mg/dl for unexposed group (p = 0.019), and at 2 weeks follow-up was 9.5±0.51mg/dl for exposed and 9.2±0.63mg/dl for unexposed group (p = 0.002). Incidence of clinical symptoms of hypocalcaemia in the exposed group was 5.1% and in the unexposed group was 25.9%. Majority of these patients had transient hypo-calcaemic symptoms in the 48-72hr time period after surgery in both the groups.Conclusions: Routine prophylactic oral calcium and Vitamin D supplementation is effective in preventing transient hypocalcaemia following total or near total thyroidectomy.

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A Prophylactic Infusion of Calcium Solution Reduces the Risk of Symptomatic Hypocalcemia in Patients after Total Thyroidectomy

Abstract: A prophylactic infusion of calcium solution after total thyroidectomy may be useful in reducing the development of symptomatic hypocalcemia and reduces the patients' risk of having discomfort and anxiety due to hypocalcemia.

Cited by 35 publications

References 22 publications

Analysis of the factors that have an effect on hypocalcemia following thyroidectomy

Analysis of the factors that have an effect on hypocalcemia following thyroidectomy

The risk of hypocalcemia in patients with parathyroid autotransplantation during thyroidectomy

A prospective study to determine the role of routine prophylactic oral calcium and vitamin D supplements in prevention of transient hypocalcaemia after total and near total thyroidectomy

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