Abstract
BackgroundHypocalcemia caused by transient or definitive hypoparathyroidism is the most frequent complication after total thyroidectomy (TT). We aimed to compare the impact of age and the clinical usefulness of oral calcium and vitamin D supplements on postoperative hypocalcemia after TT, and to determine which risk factors are important for hypocalcemia incidence.MethodsTwo hundred consecutive patients treated by TT were included prospectively in the present study. All patients supplemented oral calcium and vitamin D in the post-operative time. The data concerning symptomatic and laboratoristichypocalcemia were collected.Patients were evaluated according to age, sex, postoperative serum calcium levels, and preoperative serum alkaline phosphatasis levels.ResultsSymptomatic hypocalcemia developed only in 19 patients (9.5%), whereas laboratory hypocalcemia developed in 36 patients (18%). The risk for postoperative hypocalcemia was increate 20-fold for patients older than 50 years.ConclusionsAge is significantly associated with postoperative hypocalcemia. Implementing oral calcium and vitamin D after total thyroidectomy can reduce the incidence of hypocalcemia related to surgery.
Highlights
Hypocalcemia caused by transient or definitive hypoparathyroidism is the most frequent complication after total thyroidectomy (TT)
Even in patients who practiced a postoperative implementation with oral calcium and vitamin D, the risk of postoperative hypocalcemic crisis is not avoided, suggesting a role for other risk factors. Identifying some of this risk factors can led, in turn, to a reduction in costs associated with multiple blood samplings in monitoring the development of hypocalcemia as well as costs associated with prolonged hospitalization. The aims of this prospective clinical study are: (1) to compare the impact of age and the clinical usefulness of oral calcium and vitamin D supplements on postoperative hypocalcemia after TT, and (2) to determine which risk factors are important for hypocalcemia incidence
The postoperative serum calcium level was lower than the preoperative serum calcium level (8.9 ± 0.2 mg/dLvs 8.2 ± 0.9 mg/dL, P < 0.001)
Summary
Hypocalcemia caused by transient or definitive hypoparathyroidism is the most frequent complication after total thyroidectomy (TT). Postoperative hypocalcemia is observed in up to one third of total or completion thyroidectomy patients and is the most common complication, due to parathyroid gland insufficiency, and it continues to challenge even experienced surgeons since it often extends the duration of hospital stay and increases the need for biochemical tests [1,2,3,4,5]. Hypocalcemia after total thyroidectomy is usually transient, and the incidence of permanent hypoparathyroidism is 3% or less according to the experience of most of the surgical units studied [6,7,8]. Patients are closely observed for bleeding in the first 24 h. The main discharge-limiting factor thereafter is the development of hypocalcaemia as patients not at risk of hypocalcaemia may be discharged on day 1 following surgery
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