Incidence Of Postoperative Hypocalcemia Research Articles

Application of carbon nanoparticles in endoscopic thyroid cancer surgery: a systematic review and meta-analysis.

There has been a substantial increase in incidence of thyroid cancer globally over the past three decades, emphasizing the necessity for efficient surgical management. Surgical intervention requires meticulous lymphatic dissection; however, it is challenging to both accurately identify lymph nodes and preserve the surrounding structures. We investigated the role of carbon nanoparticles in endoscopic thyroid cancer surgery to improve surgical effects and reduce postoperative complications. Chinese and English literature databases from inception to May 2023 were searched based on inclusion criteria, and data were extracted independently by two investigators. STATA software was used for data analysis. A comprehensive systematic review and meta-analysis were conducted with 13 publications (9 randomized and 4 non-randomized controlled trials). The results demonstrated that the application of carbon nanoparticles in thyroid surgery led to an increase in the number of retrieved lymph nodes and identification of metastatic lymph nodes. Furthermore, it considerably reduced the rate of improper parathyroidectomy and the incidence of postoperative hypocalcemia. The application of carbon nanoparticles can effectively improve the effects of surgical treatment, can enhance the identification of intraoperative lymph nodes, reduce postoperative complications, and protect the integrity and function of the parathyroid gland. www.crd.york.ac.uk/PROSPERO, identifier, CRD42023420504.

The significance of short-term preoperative calcium and activated vitamin D3 supplementation in thyroidectomy: a randomized trial and prospective study.

The aim was to explore the effects of preoperative calcium and activated vitamin D3 supplementation on post-thyroidectomy hypocalcemia and hypo-parathyroid hormone-emia (hypo-PTHemia). A total of 209 patients were randomly divided into control group (CG) and experimental group (EG). Oral calcium and activated vitamin D3 supplementation were preoperatively administered to EG, whereas a placebo was administered to CG. Data on serum calcium, phosphorus, and PTH concentrations before operation, on postoperative day 1 (POPD1), at postoperative week 3 (POPW3), and on the length of postoperative hospitalization were collected. The serum calcium, phosphorus, and PTH concentrations, as well as the incidence of postoperative hypocalcemia and hypo-PTHemia, did not significantly differ between EG and CG. Subgroup analysis revealed that the serum calcium concentrations of the experimental bilateral thyroidectomy subgroup (eBTS) on POPD1 and POPW3 were higher than that of the control bilateral thyroidectomy subgroup (cBTS) (P < 0.05); the reduction of serum calcium in eBTS on POPD1 and POPW3 was less than those in cBTS (P < 0.05). However, significant differences were not observed between the unilateral thyroidectomy subgroups (UTS) (P > 0.05). Moreover, the incidence of postoperative hypocalcemia in cBTS on POPD1 was significantly higher than that in eBTS (65.9% vs 41.7%) (P < 0.05). The length of hospitalization in cBTS (3.55 ± 1.89 days) was significantly longer than that (2.79 ± 1.15 days) in eBTS (P < 0.05). Short-term preoperative prophylactic oral calcium and activated vitamin D3 supplementation could effectively reduce the incidence of postoperative hypocalcemia and decrease the length of postoperative hospitalization in patients who have undergone bilateral thyroidectomy.

Preoperative and postoperative optimisation of patients undergoing thyroid surgery: a multicentre quality improvement project at Barts Health NHS Trust

Hypocalcaemia following thyroid surgery can occur in up to 38% of patients. With over 7100 thyroid surgeries performed in 2018 in the UK, this is a common postoperative complication. Undertreated...

Serum Parathyroid Hormone and Vitamin D Levels as Predictors of Hypocalcemia after Total/ Near Total Thyroidectomy

Background: Post-operative Hypocalcaemia is the most-common complication of total and near-total thyroidectomy which is a selective treatment for benign and malignant thyroid diseases. Incidence ranges from 0.5-50%. Objectives: The role of vitamin-D and Parathyroid hormone(PTH) in incidence of Hypocalcemia after thyroidectomy has been taken into consideration. Methods: This is a prospective interventional study is conducted in Kasturba Medical College and hospital, Manipal after taking written informed consent from the participants. It aimed at surveying the serum level of preoperative Vitamin D, PTH and calcium before total-thyroidectomy surgery and its relationship with the incidence of postoperative hypocalcemia after the surgery. The study was done on 70 patients who were-planned for total/near total thyroidectomy. Preoperative Vitamin D, PTH, calcium and Postoperative 4 hours-PTH, Calcium were measured on POD-1, POD-2-4, the results obtained were then analysed. Results: Considering the cut-off of calcium as 8.6mg/dl, 42 patients developed hypocalcemia on POD-1, 28 patients on POD-2. Preoperative calcium and postoperative PTH levels in people having hypocalcaemia where significantly less compared to the patients having normal calcium. 4-hours post-operative PTH measurements showed 51% sensitivity, 100% specificity and strong co-relation between postoperative hypocalcemia and drop in PTH levels- (p=<0.001). Out of 42 patients who developed hypocalcemia 28- (65%) patients had vitamin-D deficiency(p=0.5) on POD-1 and out of 51 patients with hypocalcemia on POD 2-4, 33(78%) had-vitamin-D-deficiency(p=0.3852). Which was not statically significant. Conclusion:4 hours post-operative PTH level is a predictor of early postoperative hypocalcemia, by detecting this we can effectively manage postoperative hypocalcemia

Prospective study on the outcomes of harmonic scalpel assisted thyroidectomy in a tertiary care centre in South Kerala

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; To estimate the outcomes of thyroidectomy using harmonic scalpel in terms of intra-operative and post-operative blood loss, operating time, incidence of post-operative hypocalcaemia, incidence of recurrent laryngeal nerve and superior laryngeal nerve palsy and post-operative pain.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The patients are selected consecutively as and when they were presented during the study period. The study involved 23 patients out of which 17 underwent total thyroidectomy and 6 underwent hemithyroidectomy, all using harmonic scalpel. A complete history, physical examination and appropriate investigations were done to arrive at the correct diagnosis. Surgery was done and all the parameters were accurately assessed. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean intra-operative and post-operative blood loss in thyroidectomy by harmonic scalpel was 92.2 ml and 20.6 ml respectively. The mean operative time for thyroidectomy using harmonic scalpel was 58.2 minutes that includes 38 minutes for hemi thyroidectomy and 65.3 minutes for total thyroidectomy. Out of 23 patients, only 1 patient (4.3%) had transient hypocalcaemia in the post operative period. Three patients (13%) had transient unilateral recurrent laryngeal nerve palsy and none had superior laryngeal nerve palsy. The pain assessment by visual analog scale (VAS) score at 24 hours and 48 hours after harmonic scalpel assisted thyroidectomy were 3.87±0.97 and 2.35±1.30 respectively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Harmonic scalpel gives effective and reliable hemostasis, shortens the operative time, reduces the complications and improved pain control and hence may be considered as an effective tool in thyroidectomy.&lt;/p&gt;

Preoperative vitamin D level is significantly associated with hypocalcemia after total thyroidectomy

BackgroundTo evaluate the association of preoperative vitamin D levels with postoperative hypocalcaemia after total thyroidectomy.MethodsThe medical records of patients who underwent total thyroidectomy between May 2020 and January 2022 and who had a documented preoperative serum 25-hydroxyvitamin D (25-OHD) concentration were retrospectively reviewed. Vitamin D levels were categorized into four groups: <10 ng/mL (severe vitamin D deficiency), 10–20 ng/mL (vitamin D deficiency), 20–30 ng/mL (vitamin D insufficiency), and > 30 ng/mL (vitamin D sufficiency). Multivariate logistic regression was performed to analyse the association of vitamin D levels with the risk of hypocalcaemia after controlling for potential confounding factors.ResultsA total of 196 patients were included in this study. Of these, 47 (24.0%) had preoperative 25-OHD < 10 ng/mL, 62 (31.6%) had 25-OHD of 10–20 ng/mL, 51 (26.0%) had 25-OHD of 20–30 ng/mL and the remaining 36 (18.4%) had 25-OHD > 30 ng/mL. The incidence of postoperative hypocalcemia was highest in the group of patients with severe vitamin D deficiency (42.6% and 23.4% for postoperative laboratory and symptomatic hypocalcaemia, respectively), followed by the group with vitamin D deficiency (29.0% and 16.1%), the group with vitamin D insufficiency (19.6% and 5.9%) and the group with vitamin D sufficiency (5.6% and 2.8%). Multivariate logistic regression indicated that the odds of postoperative laboratory hypocalcaemia for patients with severe vitamin D deficiency and vitamin D deficiency were 13.20 times (95% CI: 2.69–64.79, P < 0.01) and 6.32 times (95% CI: 1.32–30.28, P = 0.02) greater than for those with vitamin D sufficiency, respectively; while the odds of symptomatic hypocalcaemia for patients with severe vitamin D deficiency was 10.18 times (95% CI: 1.14–90.86, P = 0.04) greater than for those with vitamin D sufficiency.ConclusionPreoperative vitamin D deficiency (< 20 ng/mL), especially severe vitamin D deficiency (< 10 ng/mL), is an independent predictive factor of postoperative hypocalcaemia after total thyroidectomy.

Evaluation of High Dose Preoperative Activated Vitamin D to Prevent Post Total Thyroidectomy Hypocalcemia

Abstract Background With increase in the number of thyroidectomies, the incidence of postoperative hypocalcemia has seen a rise as well. Deficiency of vitamin D has long been debated as a risk factor for post thyroidectomy hypocalcemia. The advantage of using vitamin D as a predictor for postoperative hypocalcemia may be (i) easy to estimate (ii) any deficiency can be easily corrected. Objective To determine the effectiveness of preoperative high dose calcitriol supplementation in reducing hypocalcemia following total thyroidectomy. Patients and Methods to assess the effect of preoperative vitamin D3 deficiency on post thyroidectomy hypocalcemia. For that purpose, 40 Egyptian patients for whom total thyroidectomy was performed in general surgery department at El-demerdash and Ain Shams University Specialized Hospital form March 2020 to September 2020. Patients were divided into 2 Groups; Group 1 included patients receiving preoperative single oral dose of active vit D(300000 IU) and Group 2 included patients receiving placebo instead of vit D. The incidence of postoperative hypocalcemia was investigated in all patients. Results Preoperative vitamin D measurements revealed a deficiency prevalence of 66.7% and a mean Vitamin D level of 17.09 ± 6.01. The main findings of the current study as regards to calcium was that the mean preoperative level of calcium was 9.61 ± 0.48 mg/dl, the lowest level of postoperative calcium was detected after 48 hours and 72 hours. With respect to relation between calcium and preoperative vitamin D, the results showed that there is no big difference between two groups (hypocalcemia occurred in 30% from patients in vit D group and 35% in placebo group) and no patients with normal preoperative vitamin D had a postoperative hypocalcemia 24, 48 or 72 hours after the operation. Conclusion Giving of single preoperative high dose vitamin D doesn’t reduce the overall rate of hypocalcemia after total thyroidectomy. Postoperative hypocalcemia is closely related to the preoperative vitamin D level and patients with hypovitaminosis D are more labile to develop hypocalcemia.

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.

Incidence of postoperative hypocalcaemia in patients with preoperative cytological evidence of Hashimoto’s thyroiditis undergoing thyroidectomy

Background: Hashimoto’s thyroiditis is an autoimmune pathology presents as a painless goiterogenous condition. It manifests as hypothyroidism, occurring in females of the age group 30-40. Patients are operated for cosmetic symptoms or suspicions of malignancy. The surrounding adhesions and fibrosis of the gland makes it more prone for hypocalcaemia post operatively. This study was conducted to find the incidence of hypocalcaemia postoperatively in patients with Hashimoto’s thyroiditis.Methods: Patients above 13 years undergoing total thyroidectomy where completion thyroidectomy after hemi thyroidectomy, concurrent lymph node dissection, patients on calcium therapy or the ones with preexisting hypocalcaemia were excluded from the study. 100 patients were studied from 1 January 2018 to 1 January 2019 and corrected serum calcium levels at 24 hours, 48 hours and 2 weeks estimated postoperatively. Analysis was done using CSC sepi-info software. Qualitative data were analyzed with Chi square, Z test and ANOVA test.Results: Though 32/100 patients had hypocalcemic symptoms only 26 (26%) had low calcium biochemically. The association between Hashimoto’s thyroiditis and post thyroidectomy hypocalcaemia had significant association (p&lt;0.0001). 11.53% (3/26) had recovered in 48 hours and at two weeks 10 patients remained hypocalcemic with a recovery of 61.53%.Conclusions: Hypocalcaemia after total thyroidectomy in Hashimoto’s thyroiditis occurs due to fibrosis in gland, adhesions to the adjacent structures, injury to the parathyroid glands during surgery and non-identification of parathyroid glands.

Effect of energy-based devices on post-operative parathyroid function and blood calcium levels after total thyroidectomy

ABSTRACT Introduction: Energy-based devices are widely used in thyroid surgery in order to achieve optimal hemostasis, while their role in the incidence of hypocalcemia and hypoparathyroidism comprises a topic evaluated in numerous studies. Areas covered: The aim of this systematic review is to investigate the potential benefit of Ultrasonic Shears and Electrothermal Bipolar (Radiofrequency) System in thyroid surgery regarding the incidence of post-operative hypocalcemia and hypoparathyroidism. A systematic review of the literature in PubMed/Medline and Scopus databases was conducted. Forty-nine studies met the inclusion criteria and were analyzed. A statistically decreased rate of transient hypocalcemia and hypoparathyroidism was reported in 15 studies and 4 studies, respectively, when using energy-based devices. However, 18 and 13 surveys examined transient hypocalcemia and hypoparathyroidism, respectively, and demonstrated no statistical difference between energy-based devices and conventional hemostasis. No difference was observed between the groups concerning permanent hypocalcemia. Out of 13 studies, only 2 showed a significant reduction in the occurrence of permanent hypoparathyroidism in the energy-based device group. Expert opinion: Energy-based devices reduced the rate of transient hypocalcemia and hypoparathyroidism after thyroid surgeries in 42.8% and 23.5% of the included studies, respectively. Further studies are needed to evaluate their impact on permanent post-operative hypocalcemia and hypoparathyroidism.

Clinical Application of Near-infrared Autofluorescence Detection of Parathyroid Glands in Thyroid Surgery

The purpose of this paper is to compare and analyze the advantages and disadvantages of near-infrared autofluorescence (NIRAF) imaging, nano-carbon negative imaging and conventional naked eye recognition technology in recognizing parathyroid glands during surgery, and to preliminary evaluate the effectiveness, safety and feasibility of NIRAF imaging in the recognition of parathyroid glands. The clinical trials retrospectively analyzed 36 patients, including 12 patients in Group A (NIRAF imaging group), 12 patients in Group B (nano-carbon negative imaging group), and 12 patients in Group C (conventional naked eye recognition group). The number of parathyroid glands recognized during surgery in Group A was more than that in Group B and C. The time taken to recognize parathyroid glands in Group A was shorter than that in Group B and C. There was no significant difference in the average calcium ion levels of the three groups A, B and C before surgery. After surgery, the average calcium ion level of Group A was not significantly different from that of Group B, but it was higher than that of Group C, and the difference was significant. The incidence of postoperative hypocalcemia in Group A was not significantly different from that in Group B, but it was lower than that in Group C. The incidence of postoperative symptomatic hypocalcemia in Group A was lower than that in Group B and C. Compared with traditional technology, NIRAF can recognize more parathyroid glands during surgery, take less time, and make the probability of postoperative hypocalcemia and symptomatic hypocalcemia lower during thyroid surgery. It needs noninvasive and simple operation. It is a kind of safe, effective and feasible parathyroid gland recognition technology, which is worth further exploration.

A comparative study of postoperative hypocalcaemia following total thyroidectomy in patients with Hashimoto’s thyroiditis and multinodular goitre in a rural tertiary care hospital

Background: Recurrent laryngeal nerve injury, hypothyroidism and hypocalcaemia have long been recognized as the three main sequalae of thyroidectomy. Persistent hypocalcaemia may cause intracranial lesions and cardiac arrhythmias. As the definitive diagnosis of Hashimoto’s thyroiditis was not always possible with clinical and cytological parameters when antibody testing was not done, surgery was planned with the diagnosis of multinodular goitre. This study was conducted to find out the incidence of post-operative hypocalcaemia following total thyroidectomy by skilled surgeons in patients with multinodular goitre and Hashimoto’s thyroiditis.Methods: This was a cross-sectional study to compare the incidence of hypocalcaemia in patients with biopsy-proven Hashimoto’s thyroiditis and multinodular goitre. After obtaining approval from the institutional review board and ethics committee, data was collected serially, from the surgical records of 123 patients who underwent total thyroidectomy in this tertiary care centre, during the past two years.Results: The incidence of post-operative hypocalcaemia (71.1%) in patients undergoing total thyroidectomy with Hashimoto’s thyroiditis was significantly higher than in patients with multinodular goitre (56.4%). Of the 45 patients who had a biopsy report of Hashimoto’s thyroiditis, 8 (17.8 %) developed permanent hypocalcaemia while only 8 (10.3%) of the 78 patients with histopathological diagnosis of multinodular goitre developed persistent hypocalcaemia needing supplementation following total thyroidectomy in this rural tertiary care hospital.Conclusions: The significant risk of post-operative hypocalcaemia should be kept in mind before opting for total thyroidectomy for benign lesions of the thyroid and pre-operative antibody studies must be done to diagnose Hashimoto’s thyroiditis.

Truncal Ligation of Inferior Thyroid Artery Does Not Affect the Incidence of Hypocalcaemia After Central Compartment Lymph Node Dissection.

Preserving all parathyroids with intact blood supply in situ is a desirable goal while performing total thyroidectomy (TT) and central compartment dissection (CCLND), but the same is not feasible in presence of bulky and/or matted lymph nodes in the central compartment. The aim of this study was to investigate the difference in incidence of postoperative hypocalcemia between the groups of papillary thyroid carcinoma (PTC) patients who had truncal ligation (TL) versus ligation of peripheral branches (PL) of inferior thyroid artery (ITA) during TT and CCLND. Retrospective review of prospectively kept data of PTC patients undergoing TT and CCLND. Patients were divided in two groups: Group 1-(n = 57) patients who had to undergo TL and Group 2-(n = 99) patients having PL. Clinico-pathologic profile, operative details and follow-up events were noted. Clinico-pathologic profile of both groups was comparable except for higher incidences of tumor multicentricity (p = 0.014) in Group 1. There was no significant difference in the number of parathyroids identified between the Groups (p = 0.556) but more parathyroids were auto-transplanted in Group 1 (p = 0.001). The incidence of temporary (77.2% vs 83.8, p = 0.304) and permanent hypocalcemia (7% vs 8.1%, p = 0.810) was not significantly different between the groups and neither was need for intravenous calcium. At discharge, Group 1 patients received lower dose of calcium (p = 0.001) but not of vitamin D (p = 0.769). TL of ITA during CCLND does not result in increased temporary or permanent hypocalcemia rate.

Therapeutic efficacy of two surgical methods on the secondary hyperparathyroidism.

This study aimed to investigate the clinical efficacy of two surgical methods on hyperparathyroidism secondary to uremia and summarize the advantages and disadvantages of both methods. Uremic patients who received parathyroidectomy (PTX) in the last 3 years were divided into two groups according to the surgical methods used [subtotal parathyroidectomy (SPTX) group and total parathyroidectomy + autologous implantation (TPTX + AT) group]. TPTX was performed if less than 4 glands were found during surgery. The changes of various indexes after operation, and calculate the success rate and recurrence rate of patients were observed. The serum biochemical parameters were routinely monitored, the success rate, postoperative complications and recurrence were recorded. The patients were followed up. There were 20 patients in the SPTX group and 12 in the TPTX + AT group. The success rate of surgery was 85% and 91.7% in the SPTX group and TPTX + AT group, respectively, among 32 patients included for final analysis. The mean PTH and postoperative ALP in the TPTX + AT group were slightly lower than in the SPTX group, except for the PTH levels at 6 months after surgery (P<0.05). The incidence of postoperative hypocalcemia was 100% in both groups. The incidence of wound infection in the two groups was 0% and 16.7% in the SPTX group and TPTX + AT group, respectively. The mean calcium supplementation in the TPTX + AT group was significantly more than in the SPTX group within 1 year after surgery. The mean postoperative bone mineral density in the SPTX group was significantly higher than in the TPTX + AT group. The time to postoperative remission of bone pain and muscle weakness was markedly shorter in the SPTX group than in the TPTX + AT group. The post-operative quality of life (QOL) in the SPTX group was significantly better than in the TPTX + AT group. These findings suggest that SPTX achieves a better short-term efficacy, but TPTX + AT has a better long-term efficacy. Therefore, the selection of surgical method for PTX may be based on the age, estimated survival time and possibility of kidney transplantation.

A comparative study between harmonic scalpel hemostasis and conventional hemostasis in total thyroidectomy

Background: Thyroidectomy is the most commonly performed procedure in endocrine surgery. Since the thyroid gland is highly vascular, therefore, rapid and absolute hemostasis is extremely required. Conventional thyroidectomy is commonly used with acceptable outcomes, however, it is time‑consuming and resulted in significant intraoperative blood loss with the possible risk of postoperative hemorrhage, injury to parathyroid glands and laryngeal nerves. The advent of focus harmonic devices was encouraging for improving safety, effectiveness, and reduction of operative time, especially in thyroid surgery. Aim of this study: The purpose of this study was to analyze the effectiveness and surgical outcomes of using ultrasonic harmonic scalpel for thyroid surgery compared to conventional techniques.Methods: This was a prospective, randomized study in which 60 patients with various types of goiters presented for thyroidectomy. The patients were divided into two comparable groups. Group A (30 patients) included patients who had focus harmonic thyroidectomy and Group B (30 patients) included patients who underwent conventional thyroidectomy.Results: Focus harmonic thyroidectomy showed a significant reduction in operative time, intraoperative blood loss, volume of postoperative fluid drainage and meantime for hospital stay compared with conventional thyroidectomy. There were no significant differences in the incidence of postoperative hypocalcemia, seroma, hematoma, wound infection and laryngeal nerve injury between both groups.Conclusions: Focus harmonic thyroidectomy was a safe, effective, faster, and appealing alternative to conventional technique since it reduced the operative time, intraoperative blood loss, postoperative drainage and hospital stay with comparable postoperative complications.

Hypocalcaemia after Total Thyroidectomy

Objective: To determine whether postoperative hypocalcemia after total thyroidectomy is more frequent in malignant disease than benign disease.&#x0D; Methods: This is a Cross sectional study. The sample size is 126. All the patients were selected according to the eligibility criteria by purposive sampling. Patients were analyzed for age, gender, thyroid pathology, preoperative serum calcium, postoperative serum calcium.&#x0D; Results: Postoperative hypocalcemia was found in 37 (29.37%) patients. Most patients were female (Male: Female= 1: 4.2). Patients having low preoperative serum calcium had developed more postoperative hypocalcemia (p&lt;0.03). Postoperative hypocalcemia was associated with thyroid pathology (p&lt;0.009) and age (p&lt;0.006), not associated with sex (p&lt;0.907). In multivariate analysis very little association between malignant disease and postoperative hypocalcemia was found (p&lt;0.07).&#x0D; Conclusion: The incidence of postoperative hypocalcemia following total thyroidectomy is 29.4% that is higher than the anticipated but is comparable to other published series. For total thyroidectomy surgeons should be aware of postoperative hypocalcemia but prophylactic calcium and vitamin D supplement is not mandatory in all cases.&#x0D; Bangladesh J Otorhinolaryngol; April 2019; 25(1): 19-27

A Clinical Study and Management of Hypocalcemia Following Thyroid Surgery

Background Post-thyroidectomy hypocalcaemia is a serious complication. Hypocalcaemia may occur secondarily to surgical trauma, devascularisation, unintentional removal of parathyroid glands, reoperation. Surgery has been seen as a risk factor, as in total thyroidectomy there is potential blood supply involvement resulting from bilateral surgical manipulation. This study aims to prospectively study and analyse the incidence and possible causes of hypocalcaemia following thyroid surgery, and its management. Method and Mateirals Data was collected from the patients undergoing subtotal and near total thyroidectomies from November 2012 to October 2014 by evaluating and investigating meticulous and planned for surgery. They were follow-up on day one after surgery, at the time of discharge and 6 months after surgery for post-operative hypocalcaemia. Observation 6 out of 50 patients (12%) developed postoperative hypocalcaemia, there was no incidence of permanent hypocalcaemia. Near total thyroidectomy was performed in 35(70%) patients, 1 from them (2.86%) developed hypocalcaemia and the other 5 out of 14 cases (35.71%) underwent total thyroidectomy. The hypocalcaemia was 9% in multinodular goitre (3 out of 33 patients), 20% in papillary carcinoma (1 out of 5 patients) and 40% in follicular neoplasm (2 out of 5 patients). Conclusion When preservation of parathyroid glands and their blood supply is enforced during thyroidectomy, the incidence of postoperative hypocalcaemia and permanent hypoparathyroidism can be consistently deceased.

Correlation of Primary Tumour Size and Central Compartment Lymph Nodes Metastasis in Well Differentiated Thyroid Malignancies in a Tertiary Care Centre.

Central compartment lymph nodes are the first to be involved in thyroid carcinoma and associated with higher chances of recurrence. (1) Recurrence and revision surgery can be associated with a high risk of vocal cord paralysis and hypocalcemia. (2) However, the need for central compartment lymph nodes dissection routinely in all cases of thyroid malignancies is controversial considering the risk to recurrent laryngeal nerve and parathyroids. (3) The aim of the study was to evaluate the incidence of central compartment lymph nodes metastasis in well differentiated thyroid malignancy and their correlation with size of the primary tumour along with incidence of postoperative hypocalcemia and recurrent laryngeal nerve injury after central compartment lymph node dissection. Observational study 30 patients diagnosed as well-differentiated thyroid carcinoma after fine needle aspiration cytology and planned for total thyroidectomy and central compartment lymph node dissection in the Department of ENT at a tertiary care hospital in Mysuru were studied. After surgery, histopathological examination (HPE) of thyroid and lymph node specimen was done. Postoperatively, all patients were evaluated for hypocalcemia and recurrent laryngeal nerve injury. The incidence of central compartment lymph node metastasis after HPE was 66.6%. 80% cases with tumor size ≤ 1cm and 64% cases having tumor size > 1cm showed central compartment lymph node involvement. Overall Incidence of transient Hypocalcaemia was 40%. No case of recurrent laryngeal nerve palsy was observed. In well-differentiated thyroid malignancies we found a high incidence of central compartment lymph node involvement which was even higher with primary tumour of smaller size (≤ 1cm). We did not find any incidence of permanent hypocalcemia and recurrent laryngeal nerve injury. So based on our study we emphasize on elective central compartment lymph node clearance to avoid recurrence.

Assessment of nephrotoxicity associated with combined cisplatin and mitomycin C usage in laparoscopic hyperthermic intraperitoneal chemotherapy

Background: Laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) has been used to treat various peritoneal malignancies. Cisplatin and mitomycin C (MMC) are agents commonly used in these procedures and, individually, each has been associated with acute kidney injury (AKI). There is limited literature on the complications associated with the use of both agents in HIPEC. Therefore, we sought to determine the incidence of nephrotoxicity and electrolyte abnormalities in patients undergoing laparoscopic HIPEC using this chemotherapeutic combination.Methods: We retrospectively evaluated patients undergoing laparoscopic HIPEC for gastric or gastroesophageal adenocarcinoma using both cisplatin and MMC. Sodium thiosulfate was given for renal protection and kidney function was evaluated daily up to postoperative day #2. Details regarding patient characteristics, selection criteria, chemotherapeutic regimen, perioperative lab values and anesthetic management were collected.Results: Twenty-three patients underwent 31 laparoscopic HIPEC procedures. Fifteen (65%) were male and the median age was 57 (range 21–75). Thirteen procedures were associated with an elevation in creatinine (Cr) with the median difference between POD#2 and baseline being 0.09 mg/dL (range 0–0.43). The glomerular filtration rate median difference between POD#2 and baseline was −17 mL/min/1.37 sq. m (range −42 to 11). No cases demonstrated AKI, defined as a 50% increase in Cr levels above baseline. An 84% incidence of postoperative hypophosphatemia (26/31) and 94% incidence of postoperative hypocalcemia (29/31) was observed.Conclusion: The laparoscopic approach to HIPEC using both cisplatin and MMC in our cohort was not associated with an increased incidence of AKI. The incidence of hypophosphatemia and hypocalcemia needs further evaluation to determine the exact etiology.Precis’ statement: We retrospectively studied the association of AKI with the combined use of cisplatin and MMC in laparoscopic HIPEC.

A Clinical Study and Management of Hypocalcemia Following Thyroid Surgery

Background Post-thyroidectomy hypocalcaemia is a serious complication. Hypocalcaemia may occur secondarily to surgical trauma, devascularisation, unintentional removal of parathyroid glands, reoperation. Surgery has been seen as a risk factor, as in total thyroidectomy there is potential blood supply involvement resulting from bilateral surgical manipulation. This study aims to prospectively study and analyse the incidence and possible causes of hypocalcaemia following thyroid surgery, and its management. Method and Mateirals Data was collected from the patients undergoing subtotal and near total thyroidectomies from November 2012 to October 2014 by evaluating and investigating meticulous and planned for surgery. They were follow-up on day one after surgery, at the time of discharge and 6 months after surgery for post-operative hypocalcaemia. Observation 6 out of 50 patients (12%) developed postoperative hypocalcaemia, there was no incidence of permanent hypocalcaemia. Near total thyroidectomy was performed in 35(70%) patients, 1 from them (2.86%) developed hypocalcaemia and the other 5 out of 14 cases (35.71%) underwent total thyroidectomy. The hypocalcaemia was 9% in multinodular goitre (3 out of 33 patients), 20% in papillary carcinoma (1 out of 5 patients) and 40% in follicular neoplasm (2 out of 5 patients). Conclusion When preservation of parathyroid glands and their blood supply is enforced during thyroidectomy, the incidence of postoperative hypocalcaemia and permanent hypoparathyroidism can be consistently deceased.