Is ionized calcium a reliable predictor of hypocalcemia after total thyroidectomy? A before and after study

Abstract

Hypocalcemia may be the only complication precluding a short postoperative hospital stay after total thyroidectomy (1, 2). Much has been written in the literature about the possibility of identifying (using different methods and predictors) which thyroidectomy patients will develop symptomatic hypocalcemia and which will not. Some authors (3-6) consider early postoperative (24-hour) serum calcium levels and intraoperative identification of parathyroid glands to be important predictive factors. Others (7-9) have instead suggested combining intact parathyroid hormone (PTH) and serum calcium measurements, arguing that PTH and serum calcium monitoring after the first postoperative hour would allow reliable prediction of postoperative hypocalcemia. Some authors (10-12) recommend quick PTH assay as a means of predicting postoperative parathyroid function, although others (13) found no overall significant difference in the capacity of intraoperative PTH levels, versus early postoperative serum calcium levels (day 1), to predict long-term hypoparathyroidism. In an attempt to identify reliable predictors of post-operative hypocalcemia, we measured ionized calcium levels before and after surgery and compared the data gathered with total serum calcium levels and symptoms of hypocalcemia (paresthesias and Chvostek's sign). The aim of the present study was to determine whether ionized calcium concentration is a better predictor of post-thyroidectomy hypocalcemia than total serum calcium.

Minimally invasive video-assisted thyroidectomy and transoral video-assisted thyroidectomy: A comparison of two systematic reviews

“…Like 'operative time', this variable affects the overall costs of the procedure, although this is due not so much to the method used as to the possible onset of postoperative hypocalcaemia, which can arise even as long as 48–72 h after the surgery, especially in hyperfunctioning goitres. In addition, the length of hospital stay varies according to local practices: the US authors, generally accustomed to short stays, habitually discharged their patients 24 h after TOETVA or MIVAT, whereas in the Asian and European studies hospital stays were prolonged beyond the 2 nd day, probably to monitor the levels of post-operative calcaemia;[ 40 41 42 43 44 45 46 47 48 49 50 51 52 ] this is indeed in line with our practice.…”

Predictors of postoperative hypocalcemia occurring after a total thyroidectomy: results of prospective multicenter study

“…Two other studies have demonstrated that there is an increased risk of developing permanent hypocalcemia if the level of Ca in the blood remains at 2 mmol/L or less, 1–3 weeks after surgery [ 32 , 33 ]. Tartaglia et al revealed that measurement of iCa was more reliable than measurement of Ca in post-TT patients, in the immediate and long-term follow-up [ 34 ].…”

Inferior thyroid artery ligation increases hypocalcemia after thyroidectomy: A meta‐analysis

“…Postoperative temporary hypocalcemia is the most common complication after total thyroidectomy . In most studies, the rate of postoperative hypocalcemia ranges from 6% to 55% . Its incidence has been considered an indicator of the quality of the surgical procedure in the performance of total thyroidectomy.…”

“…1 In most studies, the rate of postoperative hypocalcemia ranges from 6% to 55%. [2][3][4][5] Its incidence has been considered an indicator of the quality of the surgical procedure in the performance of total thyroidectomy. The frequency of postoperative hypocalcemia depends on many factors related to the patient such as preoperative levels of vitamin D, the indication for surgery (cancer or benign condition), the size of the gland, the need for associated neck dissection and the experience of the surgeon.…”