Early prediction of hypocalcaemia following total thyroidectomy by serial parathyroid hormone and ionized calcium assay

Background & Objective: Patients who undergo Total thyroidectomy are at higher risk for postoperative hypocalcaemia, which can lead to significant short and long term morbidity. The aim of this study was to determine the frequency of postoperative hypocalcaemia undergoing Total thyroidectomy. Methods: A total of 854 patients who underwent Total thyroidectomy and completion thyroidectomy between January 2003 to December 2016 at Endocrine Surgical unit, Jinnah Postgraduate Medical Centre, Karachi, were included in this retrospective study. Data were obtained for demographics, preoperative diagnosis, postoperative calcium levels, extent of surgery and final surgical pathology. Results: A total of 854 patients underwent Total thyroidectomy. Of these 87.58% (n=748) were malignant and 12.41% (n=106) were benign. Among the malignant and benign patients, 47.3% (n=404) underwent Total thyroidectomy and 52.69% (n=450) underwent completion thyroidectomy. Overall incidence of transient hypocalcaemia was 7% (n=60) and that of permanent hypocalcaemia was 0.11% (n= 1). Conclusion: Hypocalcaemia is one of major concern following total- thyroidectomy. Meticulous surgical techniques, identification and preservation of vascularity of parathyroid glands are essential in preventing postoperative hypocalcaemia following total thyroidectomy. How to cite this:Baloch N, Taj S, Anwer M, Naseem M. Frequency of Hypocalcaemia following Total Thyroidectomy. Pak J Med Sci. 2019;35(1):262-265. doi: https://doi.org/10.12669/pjms.35.1.93 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…The hypocalcaemia developed in 56.6% of malignant and 43% in benign thyroid disease. Our results are comparable with Kumar et al16…”

Section: Discussionsupporting

confidence: 92%

Frequency of Hypocalcaemia following Total Thyroidectomy

Baloch

Taj²,

Anwer

et al. 2019

Pak J Med Sci

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“…Our results are supported by study of Kumar et al, [31] as they reported that all patients had normal pre-operative serum PTH level. Out of 30 patients, 14 (46.67%) had intra-operative PTH below normal.…”

Section: Discussionsupporting

confidence: 91%

Early Prediction of Post Total Thyroidectomy Hypocalcaemia:Prospective Study

Elhefny¹,

Ali²,

Anter

2021

The Medical Journal of Cairo University

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Background: Post-operative hypocalcemia is the commonest complication after thyroidectomy. Post-operative hypocalcemia is a major morbidity in patients that undergone thyroidectomy. Aim of Study: We aimed in this study to study patients with increased risk to develop post thyroidectomy hypocalcaemia and to study early prediction, diagnosis and treatment. Patients and Methods: Type of study was prospective study, study setting was conducted in Ain Shams University Hospitals and Kafr El-Sheikh General Hospital, study period was 18 month from January 2019 to June 2020. Obtaining approval from The Institutional Research Board and written informed consents from the participants. Results: Most of the current study participants were females (78%) with mean age of (41.1±12.11) years. Twenty percent of patients had DM (20%), (14%) were hypertensive, (8%) had IHD and (10%) had other medical condition. Swelling was the most common clinical presentation (80%). Mutinodular goiter was the most common US finding (76%), followed be solitary solid mass (20%) and L. Ns enlargement (10%) among our study patients. Follicular lesion was the most common FNA finding (60%), followed by colloid goiter (20%) and Hashimoto's thyroiditis (8%) among our study patients. Average Ca before was 9mg/dL, and declined to be 8. 4mg/dL 24h post-operative and 8.5mg/dL 48h post-operative with statistically significant differences (p<0.001). Hypocalcemia was founded in 10 (20%) of our patients after total thyroidectomy it was manifested in 6 (12%) patients and asymptomatic in 4 (8%) patients. Conclusion: Serum calcium concentrations have been the basis of identification of post-operative hypocalcemia however this has been replaced by PTH levels being more sensitive and specific to the early prediction of transient as well as permanent hypocalcemia.

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“…Transient hypocalcaemia can also be cured by supernumery rudimentary 5th parathyroid activity at the thymic or mediastina site. Hyperparathyroidism is slightly more common after hyperthyroidism thyroidectomy, previously operated neck or thyroid carcinoma where parathyroid conservation may be risked due to some technical complications [28].…”

Section: Discussionmentioning

confidence: 99%

Frequency of Hypocalcaemia following total Thyroidectomy

Mumtaz¹,

Rehman²,

Nauman³

et al. 2021

PJMHS

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Background: The most common post-thyroidectomy complication is hypocalcaemia. It could be permanent or transitory. Permanent hypocalcaemia has a prevalence of 0-13% and transient hypocalcaemia has a prevalence of 1-6%. Aim: The study objective was to ascertain the prevalence of postoperative hypocalcaemia in patients following total thyroidectomy. Materials and Methods: This cross-sectional study was carried out on 84 thyroid patients who underwent total thyroidectomy in the surgical department of HBS General Hospital, Islamabad for period of nine months during from September 2020 to May 2021. Patients within the age range of 15-69 years and had indicated thyroidectomy caused by carcinoma thyroid, multinodular goiter, and recurrent goiter were enrolled. Inform consent was obtained from each participant. Ethical approval was taken from the institutional ethical committee. Thyroid profile and serum calcium were done for a routine investigation. Serum calcium levels were measured 24 hours, 48 hours, and 7 days after total thyroidectomy. Signs and symptoms in hypocalcaemia patients were recorded on a proforma. Patients with hypocalcaemia were followed for six months. SPSS version 20 was used for data analysis. Results: The mean age of the patients was 46.7 ± 4.6 years with an age range of 16 to 69 years. Of the total 84 patients, 38 (45.2%) underwent total thyroidectomy and 46 (54.8%) underwent a complete thyroidectomy. The prevalence of male and female patients was 22 (26.2%) and 62 (73.8%) respectively. Malignant and benign were present in 71 (84.5%) and 13 (15.5%) respectively. Of the total 84 patients, 68 (81%) developed hypocalcaemia. Out of 68 hypocalcaemia patients, 29 (42.6%) and 39 (57.4%) were from the benign and malignant groups respectively. Conclusion: Postoperatively hypocalcaemia was prevalent following thyroidectomy. Malignant patients (84.5%) were more prevalent compared to benign patients (15.5%) after total thyroidectomy. Careful surgical procedures, parathyroid gland vascularity preservation, and identification are critical in preventing hypocalcaemia following total thyroidectomy. Keywords: Hypocalcaemia; Total thyroidectomy; Complete Thyroidectomy

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Early prediction of hypocalcaemia following total thyroidectomy by serial parathyroid hormone and ionized calcium assay

Cited by 3 publications

References 10 publications

Frequency of Hypocalcaemia following Total Thyroidectomy

Frequency of Hypocalcaemia following Total Thyroidectomy

Early Prediction of Post Total Thyroidectomy Hypocalcaemia:Prospective Study

Frequency of Hypocalcaemia following total Thyroidectomy

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