Transient and permanent hypocalcemia after total thyroidectomy: Early predictive factors and long-term follow-up results

Seo, Sung Tae; Chang, Jae Won; Jin, Jun; Lim, Young Chang; Rha, Ki-Sang; Koo, Bon Seok

doi:10.1016/j.surg.2015.04.041

Cited by 78 publications

(80 citation statements)

References 33 publications

(73 reference statements)

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“…These relations have all been demonstrated before by several other studies [2, 4, 7-10, 14, 15, 18-20]. Predictors of permanent hypoparathyroidism were prolonged duration of surgery and the performance of combined central and lateral neck dissection.…”

Section: Discussionsupporting

confidence: 79%

“…How and when to best define the recovery of parathyroid gland dysfunction remains uncertain, though most studies state that PTH measurements should be done 6 or 12 months after surgery [7, 10, 13, 15, 17]. Kim et al [17] demonstrate that recovery from postoperative hypoparathyroidism may even occur as long as 2 years after surgery in patients not undergoing autotransplantation of the parathyroid glands.…”

Section: Discussionmentioning

confidence: 99%

“…One of the most common complications following total thyroidectomy is hypoparathyroidism [1-14] caused by devascularization or accidental resection of one or more of the parathyroid glands [15]. Hypoparathyroidism may be asymptomatic and self-limiting but can also lead to hypocalcaemia with symptoms of paraesthesia and muscle spasms manifesting within the first 24 h after surgery [14].…”

Section: Introductionmentioning

confidence: 99%

“…However, the condition is considered permanent when low PTH persists for at least 6–12 months after surgery [7, 10, 13, 15, 17], affecting only 0.2–10% of patients [3, 10, 15-17]. …”

Section: Introductionmentioning

confidence: 99%

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Prolonged Duration of Surgery Predicts Postoperative Hypoparathyroidism among Patients Undergoing Total Thyroidectomy in a Tertiary Referral Centre

Sonne-Holm

Hahn

2017

Eur Thyroid J

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Background: Postoperative hypoparathyroidism is a common complication following total thyroidectomy. The aim of this study was to investigate the incidence of both transient and permanent hypoparathyroidism in patients undergoing total thyroidectomy in a tertiary referral centre and, furthermore, to identify early predictive risk factors. Methods: Based on a single-institution retrospective review, we identified 582 patients who underwent total thyroidectomy between January 2010 and March 2015. Information on age, gender, pathological diagnosis, duration of surgery, autotransplantation of parathyroid glands, neck dissection, and experience and position of the surgeon was retrieved from the medical records. Furthermore, serum levels of parathyroid hormone and calcium were registered pre- and postoperatively and after 3 and 12 months. Results: The incidence of transient hypoparathyroidism during the first 24 h and 3 months after surgery was 47.8 and 17.8%, respectively. Furthermore, the incidence of permanent hypoparathyroidism 1 year after surgery was 10.7%. A prolonged duration of surgery was significantly associated with hypoparathyroidism. Moreover, autotransplantation of parathyroid glands was a significant predictor of transient hypoparathyroidism after 24 h and 3 months, but was not associated with permanent hypoparathyroidism. Conclusions: Transient and permanent hypoparathyroidism is common among patients undergoing total thyroidectomy in a tertiary referral centre. A duration of surgery >120 min constitutes an independent risk factor due to the risk of ischaemic damage. Regain of function of devascularized parathyroid glands must be expected to last at least 1 year postoperatively. Furthermore, the recovery of autotransplanted parathyroid glands should not be evaluated within 1–3 months after surgery.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…However, the condition is considered permanent when low PTH persists for at least 6–12 months after surgery [7, 10, 13, 15, 17], affecting only 0.2–10% of patients [3, 10, 15-17]. …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prolonged Duration of Surgery Predicts Postoperative Hypoparathyroidism among Patients Undergoing Total Thyroidectomy in a Tertiary Referral Centre

Sonne-Holm

Hahn

2017

Eur Thyroid J

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“…Also Seo 16 underlines how iPTH essay can be used for evaluating the possible appearance of hypocalcemia, resulting in a sensitivity and specificity of 83.4% and 100% respectively.…”

Section: Discussionmentioning

confidence: 99%

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

Pasquale¹,

Sperlongano²,

Mazzone³

et al. 2016

Surg Res Open J

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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.

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Association of Parathyroid Hormone Level With Postthyroidectomy Hypocalcemia

et al. 2018

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The existing literature regarding PTH levels to predict postthyroidectomy hypocalcemia is extremely heterogeneous. A single PTH threshold is not a reliable measure of hypocalcemia. Additional prospective studies controlled for timing of laboratory draws and a priori defined PTH thresholds need to be performed to ascertain the true prognostic significance of PTH in predicting postthyroidectomy hypocalcaemia.

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Transient and permanent hypocalcemia after total thyroidectomy: Early predictive factors and long-term follow-up results

Cited by 78 publications

References 33 publications

Prolonged Duration of Surgery Predicts Postoperative Hypoparathyroidism among Patients Undergoing Total Thyroidectomy in a Tertiary Referral Centre

Prolonged Duration of Surgery Predicts Postoperative Hypoparathyroidism among Patients Undergoing Total Thyroidectomy in a Tertiary Referral Centre

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

Association of Parathyroid Hormone Level With Postthyroidectomy Hypocalcemia

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