Early Hypocalcemia Research Articles

The use of prophylactic infusion of calcium gluconate compared to placebo in reducing the rate of early hypocalcaemia after total thyroidectomy: a double-blinded, randomized controlled trial.

Hypocalcaemia as a common complication after total thyroidectomy [23-40% in University Malaya Medical Centre (UMMC)] and could result in prolonged hospital stay. We compared the early hypocalcaemia rate between prophylactic infusion of calcium and placebo among post total thyroidectomy patients and to establish whether prophylactic intravenous infusion of calcium reduces the rate of hypocalcaemia in the first 48 hours after surgery. Patients undergoing elective total thyroidectomy in UMMC between June 2020-May 2022, were recruited and randomized to receive placebo or prophylactic calcium infusion. Both groups of patients received same dosages of post-operative prophylactic vitamin D and oral calcium. Early hypocalcaemia (within 48 hours) rate after surgery was the primary outcome and duration of hospital stay was the secondary outcome. The data collected was analysed using per-protocol analysis. Thirty-four patients were randomized equally (1:1) into both arms. No differences in the early hypocalcaemia rate between the intervention and placebo arms (0% vs. 5.8%, P>0.05). The median serum calcium levels were comparable between the intervention and placebo arms at 6 hours (2.33 vs. 2.37 mmol/L, P=0.59) and 48 hours (2.26 vs. 2.23 mmol/L, P=0.19) post-surgery. However, the median serum calcium level at 24 hours was statistically significantly higher in the intervention arm than the placebo arm (2.31 vs. 2.22 mmol/L, P=0.02). Similar duration of hospital stay between the both groups (2 vs. 2 days, P=0.81). Routine prophylactic calcium infusion with oral calcium and vitamin D does not diminish the rate of early symptomatic hypocalcaemia post total thyroidectomy in a low-risk group. However, its usefulness needs to be further assessed in a large scale randomized controlled trial (RCT) incorporating more bigger population. Registered on ClinicalTrials.gov (NCT04491357).

Association Between Admission Ionized Calcium Level and Neurological Outcome of Patients with Isolated Severe Traumatic Brain Injury: A Retrospective Cohort Study.

Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Pathophysiological processes following initial insult are complex and not fully understood. Ionized calcium (Ca++) is an essential cofactor in the coagulation cascade and platelet aggregation, and hypocalcemia may contribute to the progression of intracranial bleeding. On the other hand, Ca++ is an important mediator of cell damage after TBI and cellular hypocalcemia may have a neuroprotective effect after brain injury. We hypothesized that early hypocalcemia might have an adverse effect on the neurological outcome of patients suffering from isolated severe TBI. In this study, we aimed to evaluate the relationship between admission Ca++ level and the neurological outcome of these patients. This was a retrospective, single-center, cohort study of all patients admitted between January 2014 and December 2020 due to isolated severe TBI, which was defined as head abbreviated injury score ≥ 4 and an absence of severe (abbreviated injury score > 2) extracranial injuries. The primary outcome was a favorable neurological status at discharge, defined by a modified Rankin Scale of 0-2. Multivariable logistic regression was performed to determine whether admission hypocalcemia (Ca++ < 1.16mmol L-1) is an independent predictor of neurological status at discharge. The final analysis included 201 patients. Hypocalcemia was common among patients with isolated severe TBI (73.1%). Most of the patients had mild hypocalcemia (1 < Ca++ < 1.16mmol L-1), and only 13 (6.5%) patients had Ca++ ≤ 1.00mmol L-1. In the entire cohort, hypocalcemia was independently associated with higher rates of good neurological status at discharge (adjusted odds ratio of 3.03, 95% confidence interval 1.11-8.33, p = 0.03). In the subgroup of 81 patients with an admission Glasgow Coma Scale > 8, 52 (64.2%) had hypocalcemia. Good neurological status at discharge was recorded in 28 (53.8%) of hypocalcemic patients compared with 14 (17.2%) of those with normal Ca++ (p = 0.002). In multivariate analyses, hypocalcemia was independently associated with good neurological status at discharge (adjusted odds ratio of 6.67, 95% confidence interval 1.39-33.33, p = 0.02). Our study demonstrates that among patients with isolated severe TBI, mild admission hypocalcemia is associated with better neurological status at hospital discharge. The prognostic value of Ca++ may be greater among patients with admission Glasgow Coma Scale > 8. Trials are needed to investigate the role of hypocalcemia in brain injury.

Early Hypocalcemia in Severe Trauma: An Independent Risk Factor for Coagulopathy and Massive Transfusion.

The rapid identification of patients at risk for massive blood transfusion is of paramount importance as uncontrolled exsanguination may lead to death within 2 to 6 h. The aim of this study was to analyze a cohort of severe trauma patients to identify risk factors associated with massive transfusion requirements and hypocalcemia. All major trauma (ISS &gt; 16) presented directly from the scene to the Niguarda hospital between 1 January 2015 and 31 December 2021 were analyzed. A total of 798 patients were eligible out of 1586 screened. Demographic data showed no significant difference between hypocalcemic (HC) and normocalcemic (NC) patients except for the presence of crush trauma, alcohol intake (27% vs. 15%, p &lt; 0.01), and injury severity score (odds ratio 1.03, p = 0.03). ISS was higher in the HC group and was an independent, even if weak, predictor of hypocalcemia (odds ratio 1.03, p = 0.03). Prehospital data showed a lower mean systolic arterial pressure (SAP) and a higher heart rate (HR) in the HC group (105 vs. 127, p &lt; 0.01; 100 vs. 92, p &lt; 0.001, respectively), resulting in a higher shock index (SI) (1.1 vs. 0.8, p &lt; 0.001). Only retrospective studies such as ours are available, and while hypocalcemia seems to be an independent predictor of mortality and massive transfusion, there is not enough evidence to support causation. Therefore, randomized prospective studies are suggested.

A reappraisal of risk factors for early hypocalcemia after parathyroidectomy in dialysis patients.

We aimed to identify risk factors for early hypocalcemia after parathyroidectomy in patients with secondary hyperparathyroidism. We retrospectively enrolled 106 of 120 consecutive patients with secondary hyperparathyroidism who underwent parathyroidectomy between January 2019 and July 2021. Perioperative laboratory parameters, preoperative computerized tomography (CT) images, and postoperative histology were evaluated. Parathyroid calcification was defined as hyperdense regions with a density of > 130 Hounsfield Units on CT images of the parathyroid. Subtotal parathyroidectomy, total parathyroidectomy without auto-transplantation, or total parathyroidectomy with auto-transplantation were performed in the present study. Postoperative hypocalcemia was defined as a serum calcium concentration < 2.1mmol/L within 4days of surgery. The participants were categorized according to the presence (n = 33) or absence (n = 73) of postoperative hypocalcemia. The demographics, comorbidities, and surgical details were similar in the two groups. Multivariate analysis showed that the preoperative alkaline phosphatase activity, serum intact parathyroid hormone and calcium concentrations, and parathyroid calcification were independent risk factors for postoperative hypocalcemia (all P < 0.05). Receiver operating characteristic analysis generated areas under the curves for preoperative alkaline phosphatase, intact parathyroid hormone, and parathyroid calcification of 0.82, 0.80, and 0.70, respectively (all P < 0.05). Cut-off values for preoperative alkaline phosphatase (> 242.9IU/L) and intact parathyroid hormone (> 2,104pg/mL) were found to be predictive of postoperative hypocalcemia. High preoperative alkaline phosphatase activity and serum intact parathyroid hormone concentration and low serum calcium are associated with higher risks of postoperative hypocalcemia. Calcification of the parathyroid may represent a novel radiologic means of predicting postoperative hypocalcemia.

Early Hypocalcemia after Sub-Total, Near-Total and Total Thyroidectomy: its Diagnosis and Treatment Options

Introduction: Hypocalcemia after thyroid surgery is most important and early complication1. The main aim of this study is to diagnose early hypocalcemia after thyroid surgery and its treatment options Method: 100 patients fulfilling inclusion criteria from December 2018 to February 2021 were included in this study who had undergone thyroid surgery (sub-total, near-total and total). Serum calcium less than 8.1 mg/dl, measured after 24 hours to 48 hours of surgery is taken as hypocalcemia. Following variables are assessed in this study, gender, age, pre-operative serum calcium levels and type of surgery. Hypocalcemia diagnosed by post-operative serum calcium levels, presence of numbness, Chvostek’s sign or Trousseau’s sign noted and analyzed by SPSS v20 was used for statistical analysis. p-value less than 0.05 was considered as statistically significant. Results: Early post-hypocalcemia developed in 71 (71%) patients of them 13(18%) were males and 58 (82%) were females and female gender is significantly more associated with hypocalcemia (p=0.001) Type of surgery (sub-total, near-total and total) is not related to development of early hypocalcemia (p=0.169). Patients who developed early hypocalcemia divided into two groups- A and B respectively. Group A is treated with oral calcium alone and B with oral calcium combined with Vitamin D3. The patients followed up for 6 months. The patients who treated with oral calcium and vitamin D3 combined responded well as compares with oral calcium alone (p=.001). Conclusion: This study suggests that female gender is associated with early hypocalcemia however there is no significant different type of surgery and patients who treated with oral calcium combined with vitamin D3 responded well as compared with oral calcium alone. Keywords: Early Hypocalcemia, thyroid surgery, Goiter

Early Hypocalcemia in Pediatric Major Trauma: A Retrospective Cohort Study.

Early hypocalcemia (EH) is common in adult major trauma patients and has been associated with coagulopathy, shock, increased transfusion requirements, and mortality. The incidence of EH in pediatric severe trauma has not been investigated. We aimed to explore the incidence of EH among severely injured children. We conducted a retrospective cohort study at a tertiary children's hospital and a level 1 pediatric trauma center. We extracted the medical records of all pediatric major trauma patients, defined as an age less than 18 years and an Injury Severity Score (ISS) greater than 15, admitted after trauma team activation from January 2010 to December 2020.The primary outcome was the presence of EH. Patients were classified into 3 groups: severe hypocalcemia (ionized calcium [iCa] <1 mmol/L), hypocalcemia (1 < iCa < 1.16 mmol/L), and normal calcium (iCa ≥1.16 mmol/L). During the study period, 5126 children were hospitalized because of trauma. One hundred eleven children met the inclusion criteria. The median age was 11 years (interquartile range [IQR], 4-15), and 78.4% (87) were male. The median ISS was 21 (IQR, 17-27).Hypocalcemia was found in 19.8% (22) and severe hypocalcemia in 2.7% (3) of the patients.Although not statistically significant, hypocalcemic pediatric trauma patients had higher ISS (25.5 [IQR, 17-29] vs 21 [IQR, 17-26], P = 0.39), lower Glasgow Coma Scale (11 [IQR, 3-15] vs 13 [IQR, 7-15], P = 0.24), a more prolonged hospital stay (8 days [IQR, 2-16] vs 6 days [IQR, 3-13], P = 0.36), a more frequent need for blood products (27.3% vs 20.2%, P = 0.74), and higher mortality rates (9.1% vs 1.1%, P = 0.18) compared with normocalcemic patients. Our data suggest that in the setting of major trauma, EH is less frequent in children than previously reported in adults. Our preliminary data suggest that pediatric patients with EH may be at risk of increased morbidity and mortality compared with children with normal admission iCa requiring further studies.

Predictive value of postoperative day 1 parathyroid hormone levels for early and late hypocalcaemia after thyroidectomy

PurposeEarly parathyroid hormone (PTH) levels after total thyroidectomy can predict patients at low risk of hypocalcaemia who can be discharged early without calcium supplementation. For centres without facility to perform early PTH levels, PTH levels sent on the first postoperative day (POD1) may be an alternative. However, there is less data regarding optimal cut-off PTH levels for POD1 discharge.MethodsRetrospective review of prospective database of thyroid operations between September 2009 and February 2020 at tertiary referral centre. Main outcome measure was symptomatic hypocalcaemia.ResultsFive hundred seventy patients undergoing total (521) or completion thyroidectomy with POD1 PTH levels available were included. Among patients with POD1 PTH levels ≥ 20 pg/ml and POD1 calcium ≥ 2.0 mmol/l, the incidence of symptomatic hypocalcaemia was 1% (3/300), and need for intravenous calcium 0.3% (1/300). For POD1 PTH levels 15–19 pg/ml and POD1 calcium ≥ 2.0 mmol/l, the incidence of symptomatic hypocalcaemia and need for intravenous calcium was 5.4% (3/55). For PTH levels 10–14 pg/ml and calcium ≥ 2.0 mmol/l, the incidence of symptomatic hypocalcaemia and need for intravenous calcium was 11.7% (7/60). The risk of permanent hypoparathyroidism was < 1% for POD1 PTH levels ≥ 15 pg/ml; 5.4% for levels 10–14 pg/ml; and 19.8% for levels < 10 pg/ml.ConclusionsPOD1 PTH levels ≥ 15 pg/ml along with calcium ≥ 2.0 mmol/l are associated with low risk of symptomatic hypocalcaemia, and represent a safe criterion for discharge of most patients without calcium supplementation. For certain patient groups, a higher threshold of 20 pg/ml could be considered.

Utility of Preoperative Serum Calcium Levels as a predictor of early post thyroidectomy hypocalcemia: A Retrospective Study

Utility of Preoperative Serum Calcium Levels as a predictor of early post thyroidectomy hypocalcemia: A Retrospective Study

Assessment of risk factors for post-operative hypocalcemia after thyroid surgery

Background and Aim: Early Hypocalcemia is the most frequent complication after thyroid surgery. Several studies have tried to identify factors affecting hypocalcemia following thyroid surgery. Present study was done to evaluate risk factors for post-operative hypocalcemia after thyroid surgery. Material and Methods: This prospective study was conducted in the department of general surgery Tertiary care institute of Gujarat for the duration of 1 year in 80 patients who had undergone total, near-total thyroidectomy. Ultrasound imaging of the thyroid gland and the neck was conducted in order. Patients undergoing total/near-total thyroidectomy had their data collected through careful history collection, rigorous clinical examination, appropriate radiographic, hematological studies including serum calcium and serum albumin, operative findings, and post-operative hypocalcemia follow-up. Results: Out of the total 80 surgeries done, 20 were hemithyroidectomy and 60 were total thyroidectomy. 37 patients with swelling/goiter, 16 patients with toxic features, and 14 patients with thyroiditis underwent thyroidectom. Based on the histopathological report, Hashimoto thyroiditis was higher in the study. 4 in 11 patients with toxic multinodular goiter had hypocalcemia, followed by 5 cases with Thyroid adenomas, 1 case with Graves’ disease had hypocalcemia after thyroidectomy. 22 patients had hypocalcemia after thyroidectomy. Conclusion: The findings reveal that the only variables that influence early hypocalcemia development are sex, surgical method, and perioperative changes in serum calcium. Thus, prophylactic and therapeutic management may be quite similar to the recommendations in primary total thyroidectomies.

Early and Late Hypocalcaemia After Total Thyroidectomy Prospective Study

Abstract Background Hypocalcaemia post total thyroidectomy, is one of the most common complication observed in patients who undergo bilateral thyroid resection. Although hypocalcaemia is self-limiting in most patients and does not require treatment, symptomatic hypocalcaemia is of particular concern. We aimed to evaluate the incidence of hypocalcaemia post total thyroidectomy with evaluation of serum calcium levels as a cheap and available method so we can identify patients at risk of postoperative hypocalcaemia who require supplementation treatment, and those not at risk who can be safely discharged without any supplementation treatment. Objective To assess the incidence of postoperative hypocalcaemia post total thyroidectomy wither it’s temporary or permanent. Methods prospective analysis of 100 patients undergoing total thyroidectomy. Preservation of parathyroid glands and their blood supply was attempted in all cases. The patients were assessed for manifestations of hypocalcaemia after thyroidectomy. The assessment was done through: (1) monitoring the total and ionized calcium level 24 hours postoperatively, (2) Total and ionized calcium level was measured in the third week postoperative, (3) clinical examination and detection of symptoms and signs of hypocalcaemia, (4) In resistant cases assessment of total and ionized calcium and PTH at 3 and 6 months. Results The study included 87 females and 13 males, 37 was the mean age; 15 patients developed symptoms of hypocalcaemia (15%), 8 of them were asymptomatic but 7 of them developed symptoms, 85 patients did not develop any clinically manifested symptoms of hypocalcaemia (85%). all of them recovered from hypocalcaemia except 2 patients, one of them recovered at 3 months postoperative and the other one didn’t recover from hypocalcaemia so we diagnose it’s case as a permanent hypocalcaemia post total thyroidectomy. Conclusion Results of this study indicate that measuring calcium postoperative is a cheap and available lab investigation to indicate hypocalcaemia post total thyroidectomy, and as we mentioned before that we don’t need to prescribe calcium or vitamin D to all the patients underwent total thyroidectomy as an empirical treatment to prevent hypocalcaemia but we prescribe it just to patients developed symptoms of hypocalcaemia as it will be costly to the patient.

The Effect of Incidental Parathyroidectomy on Hypocalcemia in Benign and Malignant Thyroid Patients

Objective: Hypocalcemia is characterized by clinical findings resulting from a decrease in serum calcium (Ca2+) and many etiological factors may cause this condition. The most common cause of postoperative hypocalcemia is hypoparathyroidism and the most frequent complication that occurs after thyroid surgery is hypocalcemia. We aimed to investigate the effect of incidental parathyroidectomy on postoperative early hypocalcemia in patients after thyroid surgery.Methods: Retrospectively analyzed the data of patients who underwent thyroidectomy in General Surgery Department of Abant Izzet Baysal University between January 2009 and December 2018. Age, gender, serum Ca2+ and parathormone (PTH) levels were obtained. The histopathological results of thyroidectomy materials were grouped as benign (Group 1) and malignant (Group 2). Results: The study population was consisted of 3841 patients. 3154 patients were in group 1 and 687 patients were in group 2. The postoperative average serum Ca2+ levels of group 1 and 2 were 8.50 mg/dl (6.80-9.80) and 8,50 mg/dl (6.80-9.80), respectively (p=0.996). Postoperative PTH levels of group 1 and 2 were 44.5 ng/l (0-65) and 44.5 ng/l (0-65), respectively (p=0.979). Overall postoperative hypocalcemia (8.4 mg/dL) was observed in 1742 (45.4%) patients. There was no difference in Ca2+ and PTH levels between group 1 and group 2. Incidental parathyroidectomy (%5.4) was performed in 209 of total study population who underwent thyroidectomy. 155 (4.9%) and 54 (7.9%) of the patients in groups 1 and 2, respectively and the incidental parathyroidectomy rates of the groups were statistically different (p=0.02).Conclusion: We think that incidental parathyroidectomy does not stimulate the development of postoperative hypocalcemia.

Correlación de calcio total, calcio iónico como valor pronóstico de hipoparatiroidismo posterior a tiroidectomía total en el Instituto de Previsión Social Hospital Central – Paraguay – 2019

Introducción: La hipocalcemia es una complicación frecuente posterior a tiroidectomía total, el dosaje de la paratohormona en el posoperatorio resulta importante para identificar el riesgo de hipocalcemia sintomática precoz pos-tiroidectomía total, empero es importante identificar otros tipos de indicadores. Objetivo: correlacionar el dosaje de calcio total y calcio iónico con el dosaje de paratohormona como valor pronóstico de hipoparatiroidismo en pacientes sometidos a tiroidectomía total en el servicio de Cirugía General del Hospital Central del Instituto de Previsión Social en el periodo de junio 2018 a junio 2019. Metodología: Estudio descriptivo retrospectivo, en el que se evaluaron factores como datos demográficos, clínicos, laboratoriales y anatomopatológicos. Se emplearon las fichas médicas, quirúrgicas y de consultorio. Resultados evaluaron a 58 pacientes, 93,1%: Se eran mujeres. El promedio de edad fue de 52±14años. El 65,5% de los pacientes presentaron normocalcemia, el 13,8% Hipoparatiroidismo transitorio (HT) y el 20,7% Hipoparatiroidismo permanente (HP). Previa a la operación los pacientes presentan dosaje normal de calcio total (CAT) e ionizado (CAI); cabe resaltar que los pacientes con HP presentan dosaje de CAT y CAI menores en todos los controles y los pacientes con HT muestran un aumento al tercer control (96hs). Conclusión: Un paciente con hipocalcemia determinado con CAI a las 24h mostró un factor de riesgo de 90 veces más de HP. La medición de CAT 96hs y de CAI 24hs, mostraron una correlación alta de predecir el HP medido por PTH (r=0,734 y r=0,719, respectivamente).

Near-infrared autofluorescence in thyroid and parathyroid surgery.

Contrast-free autofluorescence (AF) of the parathyroid glands (PTGs) and thyroid tissue occurs in the near-infrared (NIR) spectrum on excitation by light in the upper range of the visible spectrum or lower NIR spectrum. In vivo, PTGs autofluoresce more brightly than thyroid (by a factor of 2-20 times) and appear as a bright spot against surrounding thyroid, muscle or fat on a processed image which is generated in real-time. NIR-AF of PTGs was first described in 2009 although NIR-AF had previously been used in several other clinical applications. Since then there has been a great amount of interest in the use of NIR-AF in thyroid and parathyroid surgery with over 25 published reports of the utilisation of both self-built and proprietary NIR-AF devices in neck endocrine surgery. All of these reports have confirmed the feasibility of NIR-AF intraoperatively and its ability to detect PTGs, although the reported accuracy varies from 90-100%. Reports of the effect of NIR-AF on relevant clinical endpoints i.e., post-operative hypoparathyroidism in thyroidectomy and persistent disease in parathyroidectomy are however scant. There has been one multicentre clinical trial of NIR-AF in thyroidectomy but this did not report clinical outcomes and two single-centre, non-randomised studies which did report post-operative hypoparathyroidism but with differing results: one showing no benefit in 106 NIR-AF vs. 163 controls and one, a reduction of early hypocalcaemia from 20% to 5% in 93 NIR-AF patients vs. 420 controls. There were only 2 cases of permanent hypoparathyroidism across both studies and therefore no significant observable difference in this key outcome variable. In parathyroidectomy, possible variability of the AF signal due to composition of a PTG adenoma, secondary/tertiary disease and MEN1 as well as depth-penetration preventing detection of sub-surface PTGs would imply that NIR-AF in its current form is not well-placed to improve cure-rates in hyperparathyroidism, which may already be as high as 98%. Thus far, no study has addressed this. Despite the promising results of NIR-AF, the absence of data demonstrating an improvement in outcomes and the cost of its use currently limit its use in routine clinical practice, especially in a publicly funded healthcare system with budgetary constraints. However, it can be utilised in research settings and this should be undertaken within the context of well-designed and conducted randomised, multi-centre, appropriately powered studies, which will assist in establishing its role in neck endocrine surgery.

Impact of incidental parathyroidectomy and mediastinal-recurrent cellular and lymph-node dissection on parathyroid function after total thyroidectomy

ObjectivesTo determine the impact of incidental parathyroidectomy and mediastinal-recurrent cellular and lymph-node dissection on parathyroid function after total thyroidectomy. Material and methodsA single-center retrospective study was conducted for a 5-year period in a university hospital center, including 605 patients undergoing total thyroidectomy, 52 of whom had mediastinal-recurrent cellular and lymph-node dissection. EndpointsThe main endpoint was intraoperative number of parathyroid glands as predictor of parathyroid hormone (PTH) level and postoperative hypocalcemia. The secondary endpoint was the correlation between associated mediastinal-recurrent cellular and lymph-node dissection and incidental parathyroidectomy and its impact on PTH level and calcemia in the immediate postoperative period and at 1 month. Results161 patients (26.61%) showed hypocalcemia in the immediate postoperative period and 12 (1.98%) at 1 month. Mediastinal-recurrent cellular and lymph-node dissection increased incidental parathyroidectomy risk 4.6-fold. Mediastinal-recurrent cellular and lymph-node dissection was associated with a statistically “suggestive” decrease in day-1 calcemia (P=0.03), and no significant decrease at 1 month (P=0.52). Incidental parathyroidectomy (6.7% of cases with parathyroidectomy versus 1.3% without) did not significantly increase the rate of early hypocalcemia (P=0.28), but was associated with a “suggestive” worsening at 1 month (P=0.02). ConclusionHypocalcemia after total thyroidectomy is a complex, probably multifactorial issue. Systematic parathyroid gland identification is not recommended due to the increased risk of gland lesion, mainly by devascularization. Incidental parathyroidectomy may induce hypocalcemia at 1 month postoperatively (statistically “suggestive” association).

Does fluoroscopy prevent inadvertent parathyroidectomy in thyroid surgery?

Near-infrared imaging may facilitate intraoperative identification of parathyroid glands by causing autofluorescence but its clinical value has not been established. Inadvertent parathyroidectomy occurs in 5-22% of thyroidectomies and is associated with temporary and permanent hypoparathyroidism. The aim of this study was to determine whether near-infrared imaging prevents inadvertent parathyroidectomy and early hypocalcaemia as a surrogate for permanent hypoparathyroidism. Near-infrared imaging was used in a prospective cohort of consecutive thyroidectomies. Thyroidectomies performed prior to the introduction of near-infrared imaging formed a control group. The thyroid bed and specimen were scanned with near-infrared imaging. Areas of autofluorescence on the specimen were examined and any parathyroid tissue found was autotransplanted. Inadvertent parathyroidectomy was therefore recorded as established intraoperatively by near-infrared imaging (allowing autotransplantation) or on subsequent histology (missed). Serum calcium and parathyroid hormone were measured on day one and at two weeks and six months postoperatively. A total of 269 patients were included: 106 near-infrared imaging and 163 controls. Inadvertent parathyroidectomy was detected by near-infrared imaging in two (and autotransplantation performed) and histologically (i.e. missed by near-infrared imaging in 13, 12.3% vs 17, 10.4% controls). Neither result was statistically significant (P = 0.08, 0.89). There was no significant difference in serum calcium or parathyroid hormone between near-infrared imaging and control groups at one day, two weeks or thereafter. Near-infrared imaging may detect inadvertent parathyroidectomy and may allow autotransplantation. It did not, however, reduce the incidence of missed inadvertent parathyroidectomy and no difference was seen in early hypocalcaemia or late hypoparathyroidism. Current near-infrared imaging technology does not appear to confer a clinical benefit sufficient to justify its use.

Postoperative hypocalcemia: analysis of factors influencing early hypocalcemia development following thyroid surgery

BackgroundEarly Hypocalcemia is the most frequent complication after thyroid surgery. Several studies have tried to identify factors (patient caracteristics or surgical technique variations) affecting hypocalcemia following thyroid surgery. This studiy evaluates the role of several factors in postoperative hypocalcemia development.MethodsA retrospective study conducted on 2108 patients that underwent thyroid surgery in a single center (1669 women and 439 men). Postoperative early hypocalcemia was defined as serum calcium levels lower than 8,0 mg/dl measured 24 h after surgery. Following factors were evaluated in the study: sex, age, glandular hyperfunction, preoperative diagnosis, preoperative serum calcium levels, preoperative serum PTH levels, type of surgery performed (total thyroidectomy vs. lobectomy); minimally invasive video assisted thyroidectomy (MIVAT); number of parathyroid preserved in situ, postoperative serum calcium levels, changes in perioperative calcium levels (difference between preoperative values ​​and postoperative calcium levels), presence of carcinoma in the surgical specimen, presence of thyroiditis based on histopatology reports.ResultsAmong evaluated factors only gender and surgical procedure revealed to be significantly correlated to early hypocalcemia development. In fact female patients experienced postoperative hypocalcemia in 42% (701/1669) of cases, which was signicantly higher than the 21.4% (94/439) identified in men. We also noticed a greater hypocalcemia incidence in patient undergoing total thyroidectomy (38.8%) than in patient undergoing lobectomy group (13.8%). Early hypocalcemia development didn’t appear to be related to preoperative serum calcium levels but it showed a statistically significant correlation with perioperative serum calcium level drop.ConclusionThis findings suggest that sex (female gender is a strong risk factor),surgical procedure and perioperative changes in serum calcium are the only factors (among all variables examined) that influence early hypocalcemia development.

Hypocalcaemia following laryngectomy: prevalence and risk factors.

To establish the prevalence of hypocalcaemia following laryngectomy and demonstrate that total thyroidectomy is a risk factor. A retrospective cohort study was conducted that included all patients who underwent total laryngectomy from 1st January 2006 to 1st August 2017. Exclusion criteria were: pre-operative calcium derangement, previous thyroid or parathyroid surgery, concurrent glossectomy, pharyngectomy, or oesophagectomy. Ninety patients were included. Sixteen patients had early hypocalcaemia (18 per cent), seven had protracted hypocalcaemia (8 per cent) and six had permanent hypocalcaemia (10 per cent). Exact logistic regression values for hypocalcaemia following total thyroidectomy compared to other patients were: early hypocalcaemia, odds ratio = 15.5 (95 per cent confidence interval = 2.2-181.9; model p = 0.002); protracted hypocalcaemia, odds ratio = 13.3 (95 per cent confidence interval = 1.5-117.1; model p = 0.01); and permanent hypocalcaemia, odds ratio = 22.7 (95 per cent confidence interval = 1.9-376.5; model p = 0.005). This is the largest study to investigate the prevalence of hypocalcaemia following laryngectomy and the first to include follow up of longer than three months. Total thyroidectomy significantly increased the risk of hypocalcaemia at all time frames and independent of other variables.

Early hypocalcaemia in neonates associated with vitamin D deficiency

Early hypocalcaemia in neonates associated with vitamin D deficiency

A prospective study on parathyroid hormone levels in detecting early hypocalcemia after total thyroidectomy

Background: Hypoparathyroidism and the resultant hypocalcaemia is a major cause of postoperative morbidity after total thyroidectomy with the incidence varying from 1% to 71%. This study aims to determine the incidence of parathyroid hormone deficiency as an earliest indicator for detecting hypocalcemia following total thyroidectomy.Methods: A prospective study was carried out among 50 subjects attending Department of Surgery, K. R. Hospital, Mysuru over a period of 12 months. Subjects of either sex undergoing total thyroidectomy had their serum parathyroid hormone levels tested at 1, 4, 12 and 24 hours after surgery were included in the study. Patients with poor compliance, calcium supplementation prior to surgery, coexisting parathyroid or renal pathology were excluded from the study. Descriptive statistics and Pearson correlation coefficients were used to analyse the results.Results: Among 50 study subjects, Hypocalcemia developed in 3 subjects (6%) 24 hours after thyroidectomy showing a sensitivity, specificity, negative and positive predictive value of 91%, 100%, 98% and 96% respectively.Conclusions: Parathyroid hormone levels in postoperative total thyroidectomy is an earliest indicator to detect symptomatic hypocalcemia subjects 24 hours after surgery, which prompts early administration of oral calcium replacement therapy in high risk subjects and potential safe early discharge post-operatively.

Use of fluorescent angiography with indocyanine green for prediction of hypocalcemia development after thyroidectomy

Introduction. The future of thyroid gland fast-track surgery depends largely on early hypocalcemia prediction. We describe our experience of using intraoperative indocyanine green fluorescent angiography (IGFA) of parathyroid glands to access their function in the early postoperative period. The study objective is to evaluate the possibility of prediction of early postoperative hypocalcemia after thyroidectomy using intraoperative indocyanine green fluorescent angiography. Materials and methods. Thirty five (35) patients with benign and malignant thyroid tumors eligible for thyroidectomy were included in the study. Intraoperative IGFA was performed using the SPY SP2000 (Novadaq Technologies Inc., Canada) device and visual assessment of vascularization of the parathyroid glands. The glands without fluorescence were considered ischemic. Ionized calcium test was performed 4, 8, and 18–24 hours after the surgery. Significance of the difference in its levels in patients with normal and ischemic parathyroid glands was evaluated. Results. In 26 patients, vascularization was considered sufficient, in 9 patients the glands were ischemic per the fluorescent examination. Statistically significant difference of ionized calcium levels were observed between groups with ischemic and normal glands at 18 hours after the surgery (mean 1.060 ± 0.53 in ischemic vs. 1.110 ± 0.56 in normal group, p &lt;0.05). Conclusion. Intraoperative IGFA of the parathyroid glands can successfully predict early postoperative hypocalcemia. Further studies for accessing correlation with permanent hypocalcemia are required.