Frequency of Hypocalcaemia following Total Thyroidectomy

Abstract

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.

The prevalence of hypocalcemia following total thyroidectomy

“…This is in contrast to previous studies, which have shown that patients with malignant conditions are more likely to develop hypocalcemia. 2,14 Nevertheless, a literature review has indicated that the prevalence of hypocalcemia was higher among patients with benign thyroid disease, which might be due to the increase in size and vascularity of the thyroid gland associated with benign diseases, such as graves and multinodular goiter, which may cause difficulties during operation. 13 However, other studies have illustrated that malignant conditions were more likely to be associated with a comorbid hypocalcemia.…”

“…13 However, other studies have illustrated that malignant conditions were more likely to be associated with a comorbid hypocalcemia. 2,14 The plausible underlying mechanism might be related to the attachment and fusion of the thyroid capsule and the parathyroid glands, which might be damaged during CCND. 15 Additionally, a retrospective study showed that CCND might increase the risk of hypocalcemia following TT, and there is a significant association between CCND and hypocalcemia (p=0.049).…”

“…5 The risk of hospitalization markedly increases in the period immediately following TT due to the symptoms of hypocalcemia. 2 Previous studies have proposed risk factors for hypocalcemia. Among them, female gender, older age, hyperthyroidism, thyroid malignancy, undergoing a follow-up surgical procedure, sub-sternal localization of thyroid tissue, undergoing cervical lymph node dissection, and having an enlarged thyroid gland have been suggested as factors associated with increase in risk of hypocalcemia.…”

“… 1 The prevalence of permanent hypocalcemia was 0.11%, while the prevalence of transient hypocalcemia 7%. 2 There are many causes of postoperative hypocalcemia (PoSH), including accidental damage or devascularization of the blood supply to the parathyroid gland during the procedure. In addition, “hungry bone” syndrome, which is an increase in the blood calcium absorption rate by the bones, may occur.…”

Outcome of one year’s experience of thyroid surgery in a high volume center.

“…The overall incidence in this study is on the lower side of the reported data in the literature; more significantly, we have achieved the lowest possible rate of permanent hypocalcemia. 23,24 Recurrent laryngeal nerve palsy may be the result of a number of iatrogenic injury mechanisms. For instance, it may be caused by direct section, thermal injury by cautery or by suture entrapment of the nerve.…”