Post-Thyroidectomy Hypocalcemia: Timing of Discharge Based on Serum Calcium Levels

Abstract

The study concerns about the evaluation of Calcium serum levels in patients who underwent total thyroidectomy. Our previous experience underlined how patients who had levels of serum Calcium more than 9 mg/dl at the first day after surgery, did not show Hypocalcemia in the next days, so that this value could be considered a good cut-off for the decision of an early discharge. With regards to this experience, the aim of our current study was to confirm the effective feasibility of an early discharge based on the levels of serum Calcium at the first post-operative day. Patients and Methods: Our study included 102 consecutive patients (82 F; 20 M, age with a range between 14-78 year sold, average 52.6) that were submitted to total thyroidectomy in the years 2010 to 2014, performed by the same operator and all done with sutureless technique (Ligasure precise © ) We classify hypocalcemia, according to their normal range (8.6 to 10.4 mg/dl), in mild (not less than 7.6 mg/dL), moderate (between 7.5 mg/dL and 7 mg/dL) and severe (less than 7 mg/dL) We classified the normal range of serum Calcium between 8.6 mg/dl and 10.4 mg/dl. Patients that showed levels of serum Calcium under this limit (<8.6 mg/dl) were treated with 6 fials of Gluconate Calcium 40 mEq in 500 ml of saline solution NaCl 0.9% i.v. (one per day), until the return to the normal range. Patients who had serum Calcium levels more than 9 mg/dl at the first post-operative days, and did not have other complications, were discharged at the same day and revaluated after 7 days. Discussion and Conclusion: Moreover our study has been useful to confirm what we observed in the previous experience, that levels of serum Calcium more than 9 mg/dl at the first postoperative day can be considered a feasible cut-off to exclude the appearance of hypocalcaemia in future. Therefore, according to our results, we assume to propose an early discharge for the patients who have serum Calcium levels more than 9 mg/dl, asking them to come back for controls one week after discharge.

Timing of hypocalcemia after total or near total thyroidectomy: a prospective observational study

“…12 In another prospective study of 102 total thyroidectomy patients by Pasquale et al, 18 patients developed hypocalcemia, 38.8% of them in the first postoperative day, 22.2% in the second postoperative day, 33.3% in the third postoperative day, and 5.5% in the fourth postoperative day. 13 Tredici et al reported a frequency rate of 50% of postoperative hypocalcemia in patients undergoing total thyroidectomy with 8% of patients developing hypocalcemia in the first postoperative day, 46% on the second day, 22% on the third day, and the remainder developed hypocalcemia on the 4th and 5th postoperative days. 9 Asari et al conducted a study to determine whether measuring serum calcium on postoperative days 1 to 4 can predict hypoparathyroidism.…”

“…4 The study results are consistent with the studies of Sperlongano et al and Pasquale et al in that the peak of hypocalcemia was in the first postoperative day. 12,13 However, it is noted that about 16.6-33.3% of patients developed hypocalcemia appeared in 3rd postoperative day. This account for a significant number of patients would be missed if they were discharged earlier on the first or second postoperative days.…”