Effectiveness of Preventative and Other Surgical Measures on Hypocalcemia Following Bilateral Thyroid Surgery: A Systematic Review and Meta-Analysis

Antakia, Ramez; Edafe, Ovie; Uttley, Lesley; Balasubramanian, Sabapathy P

doi:10.1089/thy.2014.0101

Cited by 66 publications

(63 citation statements)

References 81 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…). The reasons for exclusion of studies were a non‐randomized design, different intervention, and a preoperative intervention with no data on postoperative hypocalcaemia. Study characteristics are summarized in Table and Table S2 (supporting information).…”

Section: Resultsmentioning

confidence: 99%

“…Routine prophylactic administration of calcium and vitamin D3 after surgery, with the aim of reducing the frequency of hypocalcaemia, has been evaluated, and three previous meta‐analyses have assessed the effectiveness of this treatment. Sanabria and colleagues reported a significant decrease in the rate of symptomatic hypocalcaemia in a meta‐analysis of four RCTs and more than 700 patients.…”

Section: Introductionmentioning

confidence: 99%

“…Sanabria and colleagues reported a significant decrease in the rate of symptomatic hypocalcaemia in a meta‐analysis of four RCTs and more than 700 patients. Antakia et al . analysed only three RCTs.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Meta-analysis of routine calcium/vitamin D3 supplementationversusserum calcium level-based strategy to prevent postoperative hypocalcaemia after thyroidectomy

Sanábria

Rojas

Arevalo

2019

British Journal of Surgery

View full text Add to dashboard Cite

Background The aim was to assess the effectiveness of routine administration of calcium +/– vitamin D3 compared with a serum calcium level‐based strategy to prevent symptomatic hypocalcaemia after thyroidectomy. Methods RCTs comparing routine supplementation of calcium +/– vitamin D3 with treatment based on serum calcium levels measured after total thyroidectomy, published between 1980 and 2017, were identified in MEDLINE, Embase, LILACS and Google Scholar databases. Risk of bias was evaluated using the Cochrane Collaboration tool. Risk differences were calculated by random‐effects meta‐analysis. Meta‐regression and cumulative meta‐analysis were used to explore the best therapeutic approach. Results Fifteen studies with 3037 patients were included, and seven treatment comparisons were made. Routine supplementation with calcium + vitamin D3 offered a lower risk of symptomatic (risk difference (RD) –0·25, 95 per cent c.i. –0·32 to –0·18) and biochemical (RD –0·24, –0·31 to –0·17) hypocalcaemia than treatment based on measurement of calcium levels. The number needed to treat was 4 (95 per cent c.i. 3 to 6) for symptomatic hypocalcaemia. No publication bias was found; although heterogeneity was high for some comparisons, sensitivity analysis did not change the main results. Conclusion Routine postoperative administration of calcium + vitamin D3 is effective in decreasing the rate of symptomatic and biochemical hypocalcaemia.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Meta-analysis of routine calcium/vitamin D3 supplementationversusserum calcium level-based strategy to prevent postoperative hypocalcaemia after thyroidectomy

Sanábria

Rojas

Arevalo

2019

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…A systemic review and meta-analysis focusing on reducing post-thyroidectomy hypocalcemia found that no measures, including intra-operative PG identification, were significantly associated with reduction of hypocalcemia, given the majority of trials were of low quality due to a lack of blinding and also wide variability in study design and definitions (37). So far there is no metaanalysis specifically summarizes the relationship of intraoperative identifications of PGs with post-operative hypoparathyroidism; understandingly it would be difficult because of the very heterogeneous studies.…”

Section: Shortcomings With the Literaturementioning

confidence: 99%

To identify or not to identify parathyroid glands during total thyroidectomy

Chang

Lang

2017

Gland Surg.

View full text Add to dashboard Cite

Hypoparathyroidism is one of the most common complications after total thyroidectomy and may impose a significant burden to both the patient and clinician. The extent of thyroid resection, surgical techniques, concomitant central neck dissection, parathyroid gland (PG) autotransplantation and inadvertent parathyroidectomy have long been some of the risk factors for postoperative hypoparathyroidism. Although routine identification of PGs has traditionally been advocated by surgeons, recent evidence has suggested that perhaps identifying fewer number of in situ PGs during surgery (i.e., selective identification) may further lower the risk of hypoparathyroidism. One explanation is that visual identification may often lead to subtle damages to the nearby blood supply of the in situ PGs and that may increase the risk of hypoparathyroidism.However, it is worth highlighting the current literature supporting either approach (i.e., routine vs. selective) remains scarce and because of the significant differences in study design, inclusions, definitions and management protocol between studies, a pooled analysis on this important but controversial topic remains an impossible task. Furthermore, it is worth nothing that identification of PGs does not equal safe preservation, as some studies demonstrated that it is not the number of PGs identified, but the number of PG preserved in situ that matters. Therefore a non-invasive, objective and reliable way to localize PGs and assess their viability intra-operatively is warranted. In this aspect, modern technology such as the indocyanine green (ICG) as near-infrared fluorescent dye for real-time in situ PG perfusion monitoring may have a potential role in the future.

show abstract

“…Hipoparatiroidi gelişimi pek çok faktöre bağlı olup, ameliyat sırasında paratiroid bezlerin iyatrojenik travması, insidental paratiroidektomi, genişletilmiş tiroid cerrahisi, cerrahın deneyimi, hipertiroidi, retrosternal guatr, malignite, ikincil tiroid girişimleri ve lenf diseksiyonu yapılması bu faktörlerin arasında yer almaktadır (14). Tiroidektomi sonrası sıklıkla karşılaşılan hipokalseminin, cerrahi dışında yaş ve D vitamini eksikliği gibi faktörlere de bağlı olabileceği literatürde belirtilmekle beraber D vitamini eksikliğinin hipokalsemi açısından bağımsız bir risk faktörü olmadığını bildiren çalışmalar da mevcuttur (15,20). Serum D vitamini düzeyi ve tiroidektomi sonrası PTH düzeyi arasındaki ilişkiyi inceleyen prospektif bir çalışmada D vitamini eksikliği olan hastalarda total tiroidektomi sonrası PTH düzeyi ölçülmüştür ve bu çalışmanın sonucunda tiroidektomi sonrası PTH düzeyinin hipokalseminin şiddeti ve süresini öngörmede yetersiz bir veri olduğu belirtilmiştir (21).…”

Section: Bulgular Preoperatif Bulgularunclassified

D Vi̇tami̇ni̇ Düzeyi̇ni̇n Total Ti̇roi̇dektomi̇ Sonrasi Hi̇pokalsemi̇ Ri̇ski̇ Üzeri̇ne Etki̇si̇

Sormaz¹,

Meric²,

İşcan³

et al. 2016

İst Tıp Fak D

View full text Add to dashboard Cite

Material-Method:The records of 89 consecutive patients who underwent total thyroidectomy were retrospectively analyzed. Patients were divided into 2 groups according to preoperative vitamin D levels. In group 1(n = 63) preoperative 25-OH vitamin D level is ≤20 ng/ml, in group 2 (n=26) preoperative 25-OH vitamin D level is >20 ng/ml. Groups were compared according to their age, preoperative and postoperative corrected calcium and PTH levels. Results: The mean age was 47.8±14.1 and female/male ratio was 70/19 (3.68 / 1) in the whole group of patients. The mean preoperative PTH values was 54.8±22.6 pg/mL and the mean postoperative PTH value was 30±19 pg/ml. Postoperatively PTH and calcium levels were significantly lower than preoperative PTH and calcium levels. The demographic data showed no significant difference between two groups. The mean vitamin D level in group 1 and 2 were found 11.1±4 ng / ml and 30.6±10.4 ng / mL; respectively. Although the preoperative serum PTH levels showed statistically significant difference between the two, all were found in normal ranges. Postoperative 1 st day PTH levels were similar in two groups. Postoperative corrected calcium values showed no significant difference between group 1 and 2. Conclusion: Though vitamin D deficiency is a common entity in patients undergoing total thyroidectomy, this present study failed to show any relation between preoperative vitamin D levels and postperative hypocalcemia.

show abstract

Effectiveness of Preventative and Other Surgical Measures on Hypocalcemia Following Bilateral Thyroid Surgery: A Systematic Review and Meta-Analysis

Cited by 66 publications

References 81 publications

Meta-analysis of routine calcium/vitamin D3 supplementationversusserum calcium level-based strategy to prevent postoperative hypocalcaemia after thyroidectomy

Meta-analysis of routine calcium/vitamin D3 supplementationversusserum calcium level-based strategy to prevent postoperative hypocalcaemia after thyroidectomy

To identify or not to identify parathyroid glands during total thyroidectomy

D Vi̇tami̇ni̇ Düzeyi̇ni̇n Total Ti̇roi̇dektomi̇ Sonrasi Hi̇pokalsemi̇ Ri̇ski̇ Üzeri̇ne Etki̇si̇

Contact Info

Product

Resources

About