Risk of hypocalcemia after total thyroidectomy and bilateral central neck dissection in patients with well differentiated thyroid carcinoma.

Abstract

Background: Hypocalcaemia is a grave complication after thyroid surgery with signs ranging from paresthesia up to laryngospasm. Avoiding this complication is mandatory to avoid lifelong calcium and vitamin D supplements. Aim of the work: to assess the risk of hypocalcaemia after thyroid surgery and the factors contributing to it. Patients and methods: this study was conducted on 50 patients with well differentiated thyroid carcinoma admitted to Sayed Galal hospital and they were divided into 3 groups: A, B and C. Results: Group B patients had transient hypocalcaemia and PTH levels were in normal range, thus suffering from parathyroid dysfunction. Calcium levels returned to normal range after a mean of 15.5 days. Group C patients remained hypocalcemic for over six months and PTH levels were below normal range thus defining absolute hypoparathyroidism. In terms of age, gender, tumor size and stage, group C patients were older, had no female prevalence, had slightly larger tumors and presented at late stages. Preoperative calcium levels were not a risk factor as group C patients had the highest mean of ionized calcium and group B patients had lower mean of total calcium level than those of group C. Conclusion: The most important risk factor for post-thyroidectomy hypocalcaemia is the surgical technique. Meticulous dissection to preserve the blood supply to the parathyroid glands and careful handling of the parathyroid tissue are equally important to preserving the parathyroids themselves. Other risk factors include older age, large tumors and late stages.