Early Prediction of Post Total Thyroidectomy Hypocalcaemia:Prospective Study

Abstract

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Serum calcium concentrations have been the basis of identification of post-operative hypocalcemia however this has been replaced by PTH levels being more sensitive and specific to the early prediction of transient as well as permanent hypocalcemia.