Postoperative tetany in patients with Graves' disease: a risk factor analysis

Yamashita, Hiroyuki; Noguchi, Shiro; Tahara, Keishiro; Watanabe, Shin; Uchino, Shigehiko; Kawamoto, Hitoshi; Toda, Masakatsu; Murakami, Nobuo

doi:10.1046/j.1365-2265.1997.2201033.x

Cited by 43 publications

(42 citation statements)

References 16 publications

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“…In previous studies we have shown that postoperative tetany occurs in patients with secondary hyperparathyroidism caused by deficiencies in calcium and vitamin D due to increased demand for bone restoration after medical therapy concomitant with hypoparathyroidism after surgery [1][2][3][4].…”

Section: Thyroidectomymentioning

confidence: 99%

High Prevalence of Vitamin D Deficiency in Japanese Female Patients with Graves' Disease.

et al. 2001

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Abstract.We reported previously that vitamin D deficiency is a causal mechanism of postoperative tetany in patients with Graves' disease. The aim of the present study was to determine the prevalence of vitamin D deficiency by reviewing serum 25(OH)D levels in 208 patients with Graves' disease (146 women, 62 men) during a 1 year period. Serum 25(OH)D levels were significantly lower (p <0.001) in female Graves' patients (31.8± 13.3 nmol/1) than in male patients (41.3 ± 15.0 nmol/1). Vitamin D deficiency (defined as a serum 25(OH)D value below 25 nmol/l) was found in 40% of female patients and in 18% of male patients (p<0.005).There was a significant seasonal variation in the 25(OH)D concentrations in female patients [amplitude 6.38 (95% CI, 5.42-7.56)], with values below 25 nmol/1 found in 58% of female patients during the winter months. There were significant (p <0.001) differences in serum 25(OH)D levels between age groups in the female patients.The concentrations were lowest in patients in their twenties (25.1 ±8.2 nmol/1) and highest in patients in their fifties and sixties (43.2± 13.7 nmol/1). Serum 25(OH)D concentrations might be monitored in patients with Graves' disease during antithyroid drug therapy, and vitamin D and/or calcium supplements are recommended for patients with vitamin D deficiency.

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Section: Thyroidectomymentioning

confidence: 99%

High Prevalence of Vitamin D Deficiency in Japanese Female Patients with Graves' Disease.

et al. 2001

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“…29,30 In contrast, a large body of literature reports that female sex is associated with a significantly higher incidence of hypocalcemia compared with males. 20,24,27,28,31–34 In our study, 76% and 79% of patients who developed postoperative mild and significant hypocalcemia were female ( P = .003), respectively, and male sex was found to be independently protective against postoperative hypocalcemia.…”

Section: Discussionmentioning

confidence: 44%

“…A small number of studies have found hypocalcemia to be associated with advanced age, 15,23–25 whereas others have reported an association with younger age. 26–28 A recent meta-analysis by Edafe et al 20 evaluated age as a predictor of hypocalcemia in 2576 patients and found no significant difference in mean age between patients with hypocalcemia and those without. Conversely, in our study we observed that patients who developed postoperative mild and significant hypocalcemia were a mean of 1 and 5 years younger than patients who did not ( P = .02).…”

Section: Discussionmentioning

confidence: 99%

Early Predictors of Hypocalcemia After Total Thyroidectomy

Noureldine

Genther

Lopez

et al. 2014

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Postoperative hypocalcemia is common after total thyroidectomy, and perioperative monitoring of serum calcium levels is arguably the primary reason for overnight hospitalization. Confidently predicting which patients will not develop significant hypocalcemia may allow for a safe earlier discharge. OBJECTIVE To examine associations of patient characteristics with hypocalcemia, duration of hospitalization, and postoperative intact parathyroid hormone (IPTH) level after total thyroidectomy. DESIGN, SETTING, AND PARTICIPANTS Retrospective study of consecutive patients who underwent total thyroidectomy by a single high-volume surgeon between February 1, 2010, and November 30, 2012. Postoperative serum 25-hydroxyvitamin D (vitamin D), calcium, and IPTH levels were tested within 6 to 8 hours after surgery. Mild hypocalcemia was defined as any postoperative serum calcium level of less than 8.4 to 8.0 mg/dL. Significant hypocalcemia was defined as any postoperative serum calcium level of less than 8.0 mg/dL or the development of hypocalcemia-related symptoms. INTERVENTIONS Total thyroidectomy. MAIN OUTCOMES AND MEASURES Associations of patient demographic and clinical characteristics and laboratory values with postoperative mild and significant hypocalcemia were examined using univariate analysis, and independent predictors of hypocalcemia, duration of hospitalization, and IPTH level were determined using multivariate analysis. RESULTS Overall, 304 total thyroidectomies were performed. Mild and significant hypocalcemia occurred in 68 (22.4%) and 91 (29.9%) patients, respectively, of which the majority were female (P = .003). The development of significant hypocalcemia was associated with postoperative IPTH level (P < .001). On multivariate analysis, males had a decreased risk of developing mild (odds ratio, 0.37 [95% CI, 0.16–0.85]) and significant (odds ratio, 0.57 [95% CI, 0.09–0.78]) hypocalcemia. Every 10-pg/mL increase in postoperative IPTH level predicted a 43% decreased risk of significant hypocalcemia (P < .001) and an 18% decreased risk of hospitalization beyond 24 hours (P = .03). Presence of malignant neoplasm carried a 27% risk of mild hypocalcemia (P = .02). There was a progressively increasing risk of lower IPTH levels for each parathyroid gland inadvertently resected or autotransplanted. Male sex and African American race were independently predictive of higher IPTH levels. CONCLUSIONS AND RELEVANCE Low postoperative IPTH level, female sex, and presence of malignant neoplasm are all significant, independent predictors of hypocalcemia after total thyroidectomy. Clinicians should consider these variables when deciding how to best manage or prevent postoperative hypocalcemia.

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“…Since the number of parathyroid glands identified was actually higher in the GO group than in the non-GO group, it was not related to identifying the parathyroids but rather related to preserving the blood supply to the parathyroids. The second explanation for the higher incidence of hypoparathyroidism in GO might be related to the phenomenon of “hungry bone” syndrome after surgery as reported previously in GD after thyroidectomy [25]. Perhaps patients with active GO might have a more severe form of hungry bone syndrome.…”

Section: Discussionmentioning

confidence: 83%

Graves’ Ophthalmopathy as an Indication Increased the Risk of Hypoparathyroidism After Bilateral Thyroidectomy

Wong

Lang

2011

World j. surg.

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BackgroundStudies have evaluated the effect of thyroidectomy on the course of Graves’ ophthalmopathy (GO) but it is unclear how GO as an indication might affect surgical outcomes. We aimed to evaluate the impact of this indication on surgical outcomes in Graves’ disease (GD).MethodsFrom 1995 to 2008, 329 patients with GD underwent thyroidectomy. Patients were stratified into two groups, namely, those with GO as indication (GO) and those with non-GO indication (non-GO). Outcomes were compared between the groups and outcomes with significance were further analyzed by multivariate analyses to determine independent factors.ResultsThe GO group was significantly older (P < 0.001), had more males (P < 0.001), and fewer relapses (P < 0.001) than the non-GO group. It also had a higher proportion of total/near-total thyroidectomy (P < 0.001), despite a shorter operating time (P = 0.024) and less blood loss (P = 0.010). When only total/near-total thyroidectomy was considered, the GO group had significantly more permanent hypoparathyroidism than the non-GO group (9.2 vs. 1.6%, P = 0.038), but the rate of permanent hypoparathyroidism was similar in the two groups when only those with parathyroid autotransplantation were considered. Other complications were similar between the two groups. By multivariate analysis, GO as indication was an independent risk factor for temporary (OR 1.97, P = 0.033) and permanent hypoparathyroidism (OR 4.76, P = 0.007).ConclusionGO as a surgical indication (i.e., unstable or active GO requiring ophthalmic treatment or follow-up) was associated with increased risk of temporary and permanent hypoparathyroidism after bilateral thyroidectomy. Routine parathyroid autotransplantation may reduce the risk of permanent hypoparathyroidism in this select patient group.

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Postoperative tetany in patients with Graves' disease: a risk factor analysis

Cited by 43 publications

References 16 publications

High Prevalence of Vitamin D Deficiency in Japanese Female Patients with Graves' Disease.

High Prevalence of Vitamin D Deficiency in Japanese Female Patients with Graves' Disease.

Early Predictors of Hypocalcemia After Total Thyroidectomy

Graves’ Ophthalmopathy as an Indication Increased the Risk of Hypoparathyroidism After Bilateral Thyroidectomy

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