Mechanisms behind Post-Thyroidectomy Hypocalcemia: Interplay of Calcitonin, Parathormone, and Albumin—A Prospective Study

Chisthi, Meer M.; Nair, Reshmi; Kuttanchettiyar, Krishnakumar G.; Yadev, Induprabha

doi:10.1080/08941939.2016.1235238

Cited by 7 publications

(10 citation statements)

References 25 publications

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“…12,13,22–24,27,28,31,32,36,37,39,44,45 Positive associations were shown with post-operative calcitonin and post-operative albumin but in only one study. 18 Pre-operative vitamin D, magnesium, phosphate, creatinine, calcitonin and thyroid-stimulating hormone levels showed non-significant associations in the majority of studies where investigated. Alkaline phosphatase, albumin and T3 and T4 levels showed equivocal results from a limited number of studies.…”

Section: Resultsmentioning

confidence: 97%

“…Two surgical factors related to the parathyroid glands showed repeated significant associations with transient biochemical hypocalcaemia. These included an increasing number of parathyroid glands left in situ at the time of surgery (significant results in four of four studies 18,28,32,34 ), and evidence of parathyroid glands in the pathology specimen (8 significant results from 12 studies) 20,33,38,42,46–49 . However, other surgical factors related to the parathyroid glands do not demonstrate the same connection; a higher number of parathyroid glands identified during the procedure was more frequently not statistically significant (six of nine results were not significant 31,34,40,43,50,51 ) and equivocal results were seen when parathyroid glands are auto-transplanted (nine results significant 19,20,33,38,42,47–49,52 , eight non-significant 19,30,50,53–57 ).…”

Section: Resultsmentioning

confidence: 99%

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Predictors of post-thyroidectomy hypocalcaemia: a systematic and narrative review

2020

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AbstractObjectiveHypocalcaemia is the most common complication after total or completion thyroidectomy. This study assesses recent evidence on predictive factors for post-thyroidectomy hypocalcaemia in order to identify the patients affected and aid prevention.MethodTwo authors independently assessed articles and extracted data to provide a narrative synthesis. This study was an updated systematic search and narrative review regarding predictors of post-thyroidectomy hypocalcaemia using the Ovid Medline, Embase, Cochrane and Cinahl databases. Results were limited to papers published from January 2012 to August 2019.ResultsSixty-three observational studies with a total of 210 401 patients met the inclusion criteria. The median incidence was 27.5 per cent for transient biochemical hypocalcaemia, 12.5 per cent for symptomatic hypocalcaemia and 2.2 per cent for permanent hypocalcaemia. The most frequent statistically significant predictor of hypocalcaemia was peri-operative parathyroid hormone level. Symptomatic hypocalcaemia and permanent hypocalcaemia were seen more frequently in patients undergoing concomitant neck dissection.ConclusionMany factors have been studied for their link to post-thyroidectomy hypocalcaemia, and this study assesses the recent evidence presented in each case.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Predictors of post-thyroidectomy hypocalcaemia: a systematic and narrative review

2020

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“…It results from ischemic injury or accidental removal of the parathyroid glands during anterior neck surgery. 3,4 The consequent hypocalcemia can be transient, intermittent, or permanent. Permanent postsurgical hypoparathyroidism is defined as persistent hypocalcemia with insufficient parathyroid hormone (PTH) for more than 12 months after neck surgery; however, some consider 6 months to be enough to define the condition.…”

Section: Hypocalcemiamentioning

confidence: 99%

A 67-year-old woman with bilateral hand numbness

Radwan

Hamo

Zayed

2018

CCJM

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“…Of late, evidence is coming up to the effect that calcitonin release during gland manipulation can cause hypocalcemia even in the absence of hypoparathyroidism. 10 In the past, hospital stays of 3 to 5 days after thyroidectomy was necessary for all patients to ensure a stable calcium status in the postoperative period. 11 The modern scenario of resource constraints and insuranceled healthcare has led to efforts to perform thyroid surgery on a day-care or 23 h stay basis.…”

Section: Introductionmentioning

confidence: 99%

Serum calcium slope is a predictor of post-thyroidectomy hypocalcemia

Vasudev

Kumar

2020

Int Surg J

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Background: Hypocalcemia is a common complication following thyroidectomy. The effects of hypocalcemia can range from simple numbness to life-threatening seizures. Barring stridor, haemorrhage and hypocalcemia, other complications of thyroidectomy are not seriously morbid and hence patients can be sent home. This study sought to determine whether early postoperative calcium levels can predict hypocalcemia following thyroidectomy, to help decide on early discharge.Methods: This was a prospective cohort study, conducted between July 2016 and June 2017 among 80 consecutive patients who underwent total thyroidectomy in our department. Serum calcium values were obtained pre-operatively and at 6 and 24 hours post-operatively. Serum calcium slopes were calculated and the receiver operating characteristic curve constructed to evaluate the accuracy of risk prediction.Results: The mean total calcium levels of patients with hypocalcemia were significantly lower than the levels of the normocalcemic group. The slope of change between total calcium measurements at 6 and 24 hours in patients with hypocalcemia was found to be significantly steeper than the slope in the case of normocalcemic patients.Conclusions: It is possible to predict post-thyroidectomy hypocalcemia based on the characteristics of the early post-operative serum calcium slope. On the basis of the slope’s features, all patients except those at risk can be safely discharged home early. This can cut down on the patients’ total cost of treatment as well as save unnecessary wastage of health resources.

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Mechanisms behind Post-Thyroidectomy Hypocalcemia: Interplay of Calcitonin, Parathormone, and Albumin—A Prospective Study

Abstract: There is significant hypocalcemia within the first 24 hr after thyroidectomy, caused by calcitonin release and hypoalbuminemia. Preservation of maximum number of parathyroids in-situ can counter and normalize this hypocalcemia.

Cited by 7 publications

References 25 publications

Predictors of post-thyroidectomy hypocalcaemia: a systematic and narrative review

Predictors of post-thyroidectomy hypocalcaemia: a systematic and narrative review

A 67-year-old woman with bilateral hand numbness

Serum calcium slope is a predictor of post-thyroidectomy hypocalcemia

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