Abstract
Post-thyroidectomy hypocalcemia is a frequent complication with significant morbidity, and has been shown to increase hospital stay and readmission rates. The evaluation of serum parathyroid hormone (PTH) levels after thyroidectomy represents a reliable method to predict post-thyroidectomy hypocalcemia, but it remains infrequently used. This retrospective study investigates serum PTH values 3 h after thyroidectomy as a predictor of hypocalcemia. In this study, we enrolled 141 patients aged between 27 and 71 years eligible for total thyroidectomy who presented with multinodular goiter, suspicious nodule on cytological examination, Graves’ disease, or toxic multinodular goiter. Three hours after total thyroidectomy, 53 patients (37.6%) showed a reduction in serum PTH. Of these patients 75.5% developed hypocalcemia by 24 h after surgery and 100% were hypocalcemic after 48 h (p < 0.001). There was no significant difference attributable to the different thyroid diseases, nor to the age of the patients. PTH at 3 h after total thyroidectomy accurately predicts post-operative hypocalcemia. The early detection of patients at risk of developing post-operative hypocalcemia allows for prompt supplementation of calcium and Vitamin D in order to prevent symptoms and allows for a safe and timely discharge.
Highlights
Hypocalcemia following thyroidectomy is a frequent complication with significant morbidity and has been shown to increase hospital stay and readmission rates [1]
Postthyroidectomy hypocalcemia is due to hypoparathyroidism caused by devascularization or inadvertent resection of the parathyroid glands [2]
This study aims to evaluate the capacity of early serum parathyroid hormone (PTH) to predict the development of post-surgical hypocalcemia after thyroidectomy
Summary
Hypocalcemia following thyroidectomy is a frequent complication with significant morbidity and has been shown to increase hospital stay and readmission rates [1]. Postthyroidectomy hypocalcemia is due to hypoparathyroidism caused by devascularization or inadvertent resection of the parathyroid glands [2]. Depending on the type of damage and the number of glands involved, hypocalcemia may be transient or permanent. Preservation of the parathyroid glands during thyroid resection requires accuracy, experience, and expert knowledge of the neck anatomy [3]. The parathyroid glands vary in position (inferior parathyroid glands being more widely distributed than the superior glands), number, size, shape, and color [4]. If a parathyroid gland is clearly ischemic or hemorrhagic, auto-transplantation should be considered after confirmatory histological examination
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