Assessment of Hypocalcemia Following Total Thyroidectomy for Benign Thyroid Lesions: To Be Continued or Not?

Abstract

Background: Thyroidectomy is one of the most common operations performed worldwide by various surgeons whether general or endocrine surgeons. The rate of complications following thyroidectomy has been progressively decreasing yet it still carries significant morbidity if preoperative preparation and patient as well as procedure selection were not optimized. Objective: This study was designed to evaluate the problem of hypoparathyroidism following thyroid surgery and to assess the use of parathyroid hormone (PTH) level to predict patients with risk of postoperative hypocalcemia. Through this study, it was sought that we could reach a recommendation to rely on the routine technique of total thyroidectomy and utilization of PTH assay to allow for a safe and timely discharge of patients with normocalcemia and for the early identification of patients requiring treatment of post thyroidectomy hypocalcemia. Patients and Methods: This prospective study included 50 patients from two different hospitals undergoing total thyroidectomy to evaluate the efficacy of postoperative serum PTH and calcium (Ca) levels as an early and accurate predictor of post-thyroidectomy hypocalcemia. Ionized serum calcium as well as PTH were measured for each patient preoperatively, intraoperatively (just after skin closure), at every day postoperative when patient admitted and after one month in patients with hypocalcemia. Results: Our results showed an overall incidence of 18% of hypocalcemia after total thyroidectomy. Of them, only 6% developed symptomatic hypocalcemia. Transient hypocalcemia occurred in 4% of patients while permanent hypocalcemia affected 2%. Conclusion: Serum calcium concentrations have been the basis of identification of post-operative hypocalcemia, however this has been replaced by PTH levels being more sensitive and specific to the early prediction of transient as well as permanent hypocalcemia. Postoperative PTH; also known as quick PTH assay, level of < 12 pg/ml was found to have an overall accuracy of 98% in early prediction of permanent hypocalcemia in our study.