Post-thyroidectomy Hypocalcemia Research Articles

Early Prediction of Post Total Thyroidectomy Hypocalcaemia:Prospective Study

AbstractBackground: Post-operative hypocalcemia is the common-est complication after thyroidectomy. Post-operative hypoc-alcemia is a major morbidity in patients that undergonethyroidectomy.Aim of Study: We aimed in this study to study patientswith increased risk to develop post thyroidectomy hypocal-caemia and to study early prediction, diagnosis and treatment.Patients and Methods: Type of study was prospectivestudy, study setting was conducted in Ain Shams UniversityHospitals and Kafr El-Sheikh General Hospital, study periodwas 18 month from January 2019 to June 2020. Obtainingapproval from The Institutional Research Board and writteninformed consents from the participants.Results: Most of the current study participants werefemales (78%) with mean age of (41.1±12.11) years. Twentypercent of patients had DM (20%), (14%) were hypertensive, (8%) had IHD and (10%) had other medical condition. Swellingwas the most common clinical presentation (80%). Muti-nodular goiter was the most common US finding (76%),followed be solitary solid mass (20%) and L. Ns enlargement (10%) among our study patients. Follicular lesion was themost common FNA finding (60%), followed by colloid goiter (20%) and Hashimoto's thyroiditis (8%) among our studypatients. Average Ca before was 9mg/dL, and declined to be 8.4mg/dL 24h post-operative and 8.5mg/dL 48h post-operativewith statistically significant differences (p < 0.001). Hypocal-cemia was founded in 10 (20%) of our patients after totalthyroidectomy it was manifested in 6 (12%) patients andasymptomatic in 4 (8%) patients.Conclusion: Serum calcium concentrations have been thebasis of identification of post-operative hypocalcemia howeverthis has been replaced by PTH levels being more sensitiveand specific to the early prediction of transient as well aspermanent hypocalcemia.

The Optimal Parathyroid Hormone Cut-Off Threshold for Early and Safe Management of Hypocalcemia After Total Thyroidectomy

ObjectiveTo define optimal intact parathyroid hormone (iPTH) cut-off threshold predictive of hypocalcemia after total thyroidectomy for safe and effective postoperative management. MethodsThis prospective single center study was done in 2 phases. In phase I, predictors of symptomatic hypocalcemia were analyzed and the receiver operating characteristic curve was used to define the optimal iPTH cut-off threshold predictive of hypocalcemia. Phase II studied giving prompt prophylactic supplemental calcium and vitamin D to all patients who had iPTH levels below the calculated threshold, while phase I patients were given prompt selective supplementation if they had postoperative hypocalcemia or symptoms. ResultsUnivariate analysis of patients in phase I showed that postoperative iPTH was the only significant variable that can predict symptomatic hypocalcemia. Using receiver operating characteristic curve and Youden index, the confirmed optimal cut-off threshold predictive of hypocalcemia was iPTH 19.95 pg/mL, with area under the curve of 0.903, 100% sensitivity, negative predictive value, and highest Youden index, while iPTH 15 pg/mL and iPTH 10 pg/mL were less optimal. Symptomatic hypocalcemia occurred in 30% of the phase I cohort who received selective supplementation versus 3% of those in the phase II cohort who received prophylactic supplementation. Return to emergency department and need for intravenous calcium were also significantly better in phase II. ConclusioniPTH cut-off for post-thyroidectomy hypocalcemia was 19.95 pg/mL. Low-risk patients were discharged with no supplementation while all high-risk patients received prompt calcium and vitamin D supplementation, which led to effective hypocalcemia management and safe 24-hour discharge.

Does Preoperative Calcium and Calcitriol Decrease Rates of Post-Thyroidectomy Hypocalcemia? A Randomized Clinical Trial

Postoperative hypocalcemia is the most common complication after thyroidectomy. Postoperative supplementation with calcium and calcitriol reduces its occurrence; however, prophylactic preoperative supplementation has not been studied systematically. The primary objective of this study was to determine whether pre- and postoperative calcium and calcitriol supplementation reduces postoperative hypocalcemia after total thyroidectomy compared with postoperative supplementation alone. We conducted a single-institution prospective randomized trial enrolling 82 patients undergoing total thyroidectomy from July 2017 through May 2019. Those undergoing partial thyroidectomy or concurrent planned parathyroidectomy were excluded. The intervention group started calcitriol 0.25 μg po bid and calcium carbonate 1,500 mg po tid 5 days preoperatively and continued postoperatively. The control group started these medications postoperatively. The primary end point was clinical or biochemical hypocalcemia. Secondary outcomes were postoperative calcium levels, need for intervention, length of stay, and readmission. Thirty-eight patients were randomized to the intervention group and 44 to the control group. There were 12 episodes of hypocalcemia; 5 (13.2%) in the intervention and 7 (15.9%) in the control group (p= 0.76). No differences were found in secondary outcomes; including postoperative calcium levels at each measured time point, need for intervention (n= 10 [26.3%], n= 15 [34.1%]; p= 0.48), length of stay (mean [SD] 32.3 [15.6] hours, 30.7 [10.5] hours; p= 0.6), or readmissions (n= 0 [0.0%], n= 3 [6.8%]; p= 0.24). Starting supplementation with calcium and calcitriol preoperatively does not reduce postoperative hypocalcemia compared with postoperative supplementation alone after total thyroidectomy. These findings do not support the practice of routine calcium and calcitriol supplementation before total thyroidectomy.

Role of postoperative intact serum PTH as an early predictor of severe post-thyroidectomy hypocalcemia: a prospective study.

Post thyroidectomy hypocalcemia is a major sequel of thyroidectomy and continues to trouble the endocrinologists and the endocrine surgeons as there is no ideal predictive marker of hypocalcemia which has the potential to develop into a life-threatening complication. The role of early serum intact parathormone (iPTH) to predict post thyroidectomy hypocalcemia is becoming useful but the literature is still unclear regarding the optimal time of testing and the optimal cut-off value of serum iPTH. This is a prospective cohort study of 111 patients who underwent total thyroidectomy in a tertiary care endocrine surgery referral unit. Serum iPTH was measured after 20min and 4h of surgery. Receiver-Operator characteristic Curve (ROC) was used to find out of the best cut-off value of S. iPTH 20min and 4h after surgery in predicting hypocalcemia. Hypocalcemia was noted in 60 (54%) out of 111 subjects who underwent total thyroidectomy. The best cut-off values of Serum iPTH to predict hypocalcemia was found to be 4.28pmol/l at 20min post total thyroidectomy with a sensitivity and specificity of 81.7% and 51%, respectively. In addition, patients with malignancy or central lymph nodal dissection were significantly over-represented in the hypocalcemia group with serum iPTH above the threshold level of 4.28pmol/l. Below the cut off level, parenteral calcium supplementation was required in 23% (17/74) subjects while the rate was only 5.4% (2/37) patients when serum iPTH was above the cut-off level. The decline of serum iPTH below a specific level after surgery has predictive value together with other factors strictly related to patient, the thyroid disease itself and surgery. The risk of development of hypocalcemia and consequent need for calcium supplementation should be evaluated by clinical assessment along with serum PTH measurement.

Post-thyroidectomy hypocalcaemia in Al-Nasiriya city in 2019: gender difference

Post-thyroidectomy hypocalcaemia in Al-Nasiriya city in 2019: gender difference

Electrosurgical energy. Is it a risk factor for post-thyroidectomy hypocalcaemia?

Aim and objective: The aim of this study was to investigate a relationship between the different types of electrosurgical energy (monopolar, bipolar, and ultrasonic-harmonic scalpel) and postoperative hypocalcaemia after total thyroidectomy. Additionally, to analyze the frequency of postoperative hypocalcaemia, according to age group, gender, and pathological diagnosis. Materials and Methods: An observational, retrospective and correlational study was carried out in a series of patients who underwent total thyroidectomy in a public and a private hospital in Quito, Ecuador, South America, from January 2016 to July 2019. Results: Among 665 patients, post-thyroidectomy hypocalcaemia was observed in 127 (18.8%) patients. There was no significant difference between males and females. Hypocalcaemia was significantly higher in patients aged between 26 and 35 years, patients operated for malignant tumors and in patients in whom at least one parathyroid gland was removed. Postoperative hypocalcaemia occurred in 52.2% of patients (n = 24) [RR: 3.14; 95% CI: 2.26-4.36; p: 0.001] in the bipolar group, 29.2% (n = 7) [RR: 1.56; 95% CI: 0.82-2.97; p: 0.087] in the harmonic group, 17.3% (n = 34) [RR: 0.87; 95% CI: 0.61-1.24; p: 0.219] in the monopolar group, and 15.2% (n= 60) [RR: 0.61; 95% CI 0.45-0.84; p: 0.001] in the monopolar + harmonic group. Conclusions and clinical significance: The use of a bipolar device appears to be a risk factor for hypocalcaemia, while the use of monopolar + harmonic seems to be a protective factor. Although, when analyzing monopolar + harmonic vs monopolar alone, the addition of the harmonic scalpel didn’t provide statistically significant additional protection against hypocalcaemia.

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

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.

Refractory hypercapnic respiratory failure in an elderly female

The most common cause of hypercapnic respiratory failure is acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Many other factors can contribute to hypercapnia and may lead to refractory hypercapnia in AECOPD. One of the important causes is electrolyte imbalance. We report a case of refractory hypercapnic respiratory failure in an elderly female due to postthyroidectomy hypocalcemia. The patient responded well after the correction of hypocalcemia.

Serum calcium slope is a predictor of post-thyroidectomy hypocalcemia

Background: Hypocalcemia is a common complication following thyroidectomy. The effects of hypocalcemia can range from simple numbness to life-threatening seizures. Barring stridor, haemorrhage and hypocalcemia, other complications of thyroidectomy are not seriously morbid and hence patients can be sent home. This study sought to determine whether early postoperative calcium levels can predict hypocalcemia following thyroidectomy, to help decide on early discharge.Methods: This was a prospective cohort study, conducted between July 2016 and June 2017 among 80 consecutive patients who underwent total thyroidectomy in our department. Serum calcium values were obtained pre-operatively and at 6 and 24 hours post-operatively. Serum calcium slopes were calculated and the receiver operating characteristic curve constructed to evaluate the accuracy of risk prediction.Results: The mean total calcium levels of patients with hypocalcemia were significantly lower than the levels of the normocalcemic group. The slope of change between total calcium measurements at 6 and 24 hours in patients with hypocalcemia was found to be significantly steeper than the slope in the case of normocalcemic patients.Conclusions: It is possible to predict post-thyroidectomy hypocalcemia based on the characteristics of the early post-operative serum calcium slope. On the basis of the slope’s features, all patients except those at risk can be safely discharged home early. This can cut down on the patients’ total cost of treatment as well as save unnecessary wastage of health resources.

The utility of serum 25-hydroxyvitamin D in predicting post-thyroidectomy hypocalcemia in thyrotoxic subjects: a single-center cohort study

Background: The role of preoperative vitamin D deficiency as a predictor of post-thyroidectomy hypocalcemia in thyrotoxic subjects is controversially reported. This prospective cohort study determined the utility of serum 25-hydroxyvitamin D (25OHD) levels in predicting transient hypocalcemia in thyrotoxic and euthyroid patients undergoing total thyroidectomy (TT).Methods: Subjects with new-onset hyperthyroidism (n=97; age=median (Inter-Quartile Range); 38 (18) years; M:F=25:72) and age; sex-matched euthyroid cohorts (n=231; age=37 (18) years; M:F=40:191) undergoing TT were evaluated for serum corrected-calcium, intact parathormone and 25OHD levels at baseline, 48-hour and 6-months post-TT, p value &lt;0.05 was considered significant.Results: The incidence of transient hypocalcemia in thyrotoxic subjects was 58.8% (57/97) versus 22.5% (52/179) in euthyroid cohorts. In receiver operating characteristic analysis predicting transient hypocalcemia for the test-variable preoperative 25OHD, the area under curve (AUC) among euthyroid subjects was 0.725 (95% CI: 0.641-0.809; p&lt;0.001) with a threshold of 17.6 ng/mL with sensitivity and specificity of 65.4% and 64.2% respectively. In thyrotoxic subjects, the AUC was 0.573 (95% CI; 0.452-0.694; p=0.222) with poorer predictability and was less than that of euthyroid subjects.Conclusions: Preoperative 25OHD below 17.6 ng/ml was reliable in predicting transient postoperative hypocalcemia in euthyroid subjects though with a limited sensitivity and specificity but unreliable in thyrotoxic subjects undergoing TT.

Methylene Blue Spray for Identification of Parathyroid Glands During Thyroidectomy.

Background: Hypocalcaemia is a common delayed complication after thyroidectomy. Several studies have identified risk factors and possible ways to prevent post-thyroidectomy hypocalcemia. The purpose of our study is to evaluate the effectiveness of an intraoperative methylene blue spray to identify parathyroid glands during thyroidectomy.Materials and methods: We have conducted a prospective non-randomised cohort study with 50 patients who underwent hemithyroidectomy or total thyroidectomy between January 2019 and January 2020. During thyroidectomy, 1 ml (10 mg) of 1% methylene blue was sprayed over the parathyroid glands, the inferior thyroid artery, and the recurrent laryngeal nerve.Results: Our study included 50 patients with ages ranging from 18 to 80 years old (43.0±9.7). We were able to identify the parathyroid glands with the intraoperative methylene blue spray in 82% of cases, with no significant postoperative complications.Conclusion: Our study concludes that the methylene blue spray is a safe, feasible, and effective technique to identify parathyroid glands.

Histopathological pattern of thyroid diseases and its correlation with post-thyroidectomy hypocalcemia: a prospective study in iodine-sufficient Southern India

Background: Increasing incidence of thyroid diseases requiring surgery and postoperative hypocalcemia after total thyroidectomy (TT) remains a concern. This prospective study evaluated the correlation between the histopathologic pattern of thyroid disease and the development of temporary and permanent hypocalcemia (&gt;6 month) post-TT.Methods: Demographics and clinical profile of consecutive patients undergoing TT were documented. The final diagnosis was confirmed with histopathological examination (HPE) of thyroidectomy specimen. Serum corrected-calcium and intact parathormone was measured at baseline, 48-hour and 6-month post-TT.Results: Out of 328 subjects (mean age=35.5 year; M:F=65:263), 33.4% (n=109) and 7.6% (n=26) developed temporary and permanent hypocalcemia [calcium=8 mg/dl] post-TT. HPE comprised colloid goitre 33.2% (n=109), follicular adenoma 1.8% (n=6), Hashimoto’s/lymphocytic thyroiditis 16.8% (n=55), Graves’ disease 14% (n=46), adenomatous hyperplasia 19.8% (n=65), papillary thyroid carcinoma (PTC) 13.4% (n=44), follicular carcinoma 0.3% (n=1), medullary carcinoma 0.3% (n=1) and anaplastic carcinoma 0.3% (n=1). Multinomial regression analysis revealed that temporary hypocalcemia was associated with graves’ disease (Odds ratio: 11.6), PTC (10.3), follicular adenoma (16.7) and thyroiditis (17.5), while permanent hypocalcemia was associated only with thyroiditis (3.2), each p&lt;0.01.Conclusions: Graves’ disease, thyroiditis and malignancy increased the risk of temporary post-thyroidectomy hypocalcemia by many-fold. Subjects with thyroiditis had 3.2-fold increased likelihood for developing permanent hypocalcemia. Hence thyroiditis, a benign pathology warrants high threshold for surgery with meticulous intraoperative dissection and in-situ preservation of parathyroid glands.

Papillary Thyroid Carcinoma in Children: Clinicopathological Profile and Outcomes of Management.

We aim to analyze the clinicopathological profile and outcomes of management for children with papillary thyroid carcinoma (PTC). Relevant clinical data of children ≤ 18years of age managed for PTC between January 2006 and July 2018 as well as details of their follow-up till December 2019 were retrospectively collected and analyzed. There were 82 children with PTC that were managed during the study period. At presentation, 39 (47.6%) had cervical lymphadenopathy, while 9 (11%) had systemic metastasis. Majority of patients 39 (47.6%) underwent total thyroidectomy with a selective neck dissection, while total thyroidectomy alone was performed in 26 (31.7%). Following surgery, hypocalcemia was seen in 39 (47.6%): 28 (34.1%) were temporary, while 11 (13.4%) were permanent. Twenty-eight (34%) developed persistent disease after surgery and 131I therapy. Significant risk factors for persistence and metastatic disease were metastatic cervical lymph node at presentation (p = 0.002) and tumor size (p = 0.014), respectively. The mean duration of follow-up was 60.3 (range 12-150) months with a mean overall disease-free survival of 60months (95% CI 57.11, 77.95). Children with papillary thyroid cancers present with aggressive disease, 47.6% with cervical nodal metastasis and 11% with distant metastasis in this cohort. The rate of post-thyroidectomy hypocalcemia in this study is substantial, and efforts to reduce it are actively being pursued. The presence of metastatic cervical lymph node at presentation (p = 0.002) and tumor size (p = 0.014) were the only significant risk factors for persistent and metastatic disease, respectively, in this study.

Development and validation of a new model for predicting hypocalcaemia after total thyroidectomy: the NuGra model

Hypocalcaemia is the most frequent complication after total thyroidectomy. Finding a method for its early detection has become a priority. A single-center prospective cohort study was conducted to identify risk factors for postoperative hypocalcaemia, develop an early detection model, and test its validity in a different group of patients. The sample was composed of patients who underwent a total thyroidectomy between May 2012 and September 2015. Demographic, clinical, laboratory, and surgical data were collected. The incidence of hypocalcaemia and permanent hypoparathyroidism was calculated. Bivariate and multivariate analysis identified several independent predictors of hypocalcaemia, which were used to design a predictive model. The validity of the model was subsequently tested in a different cohort. Area under the ROC curve (AUROC) was calculated to determine its predictive power. The study and validation groups included 352 and 118 patients, respectively. Seventy-three patients developed laboratory-confirmed hypocalcaemia (20.7%), and symptomatic in 43 (12.2%). Multivariate analysis confirmed as independent predictors of hypocalcaemia the higher number of parathyroid glands identified [OR 1.41(0.98, 2.02); p = 0.063] and pre-to-postoperative gradient of parathormone decline [OR 1.06(1.04, 1.08); p < 0.001]. Based on these variables, the NuGra (Number of parathyroid glands identified-Gradient of decline) model was developed for predicting laboratory-confirmed hypocalcaemia. Its predictive power was high (AUROC 0.902, CI 0.857-0.947) for the study and the validation group (AUROC 0.956, CI 0.919-0.993). A higher number of parathyroid glands identified and a higher gradient of parathormone decline are risk factors for post-thyroidectomy hypocalcaemia. The NuGra model is useful for early prediction of individual risk for hypocalcaemia.

The challenges of post-bariatric surgery hypocalcaemia in pre-existing hypoparathyroidism.

SummaryConventional treatment of hypoparathyroidism relies on oral calcium and calcitriol. Challenges in managing post-parathyroid- and post-thyroidectomy hypocalcaemia in patients with a history of bariatric surgery and malabsorption have been described, but postoperative management of bariatric surgery in patients with established hypoparathyroidism has not. We report the case of a 46-year-old woman who underwent elective sleeve gastrectomy on a background of post-surgical hypoparathyroidism and hypothyroidism. Multiple gastric perforations necessitated an emergency Roux-en-Y gastric bypass. She was transferred to a tertiary ICU and remained nil orally for 4 days, whereupon her ionised calcium level was 0.78 mmol/L (1.11–1.28 mmol/L). Continuous intravenous calcium infusion was required. She remained nil orally for 6 months due to abdominal sepsis and the need for multiple debridements. Intravenous calcium gluconate 4.4 mmol 8 hourly was continued and intravenous calcitriol twice weekly was added. Euthyroidism was achieved with intravenous levothyroxine. Maintaining normocalcaemia was fraught with difficulties in a patient with pre-existing surgical hypoparathyroidism, where oral replacement was impossible. The challenges in managing hypoparathyroidism in the setting of impaired enteral absorption are discussed with analysis of the cost and availability of parenteral treatments.Learning points:Management of hypoparathyroidism is complicated when gastrointestinal absorption is impaired.Careful consideration should be given before bariatric surgery in patients with pre-existing hypoparathyroidism, due to potential difficulty in managing hypocalcaemia, which is exacerbated when complications occur.While oral treatment of hypoparathyroidism is cheap and relatively simple, available parenteral options can carry significant cost and necessitate a more complicated dosing schedule.International guidelines for the management of hypoparathyroidism recommend the use of PTH analogues where large doses of calcium and calcitriol are required, including in gastrointestinal disorders with malabsorption.Approval of subcutaneous recombinant PTH for hypoparathyroidism in Australia will alter future management.

Hypocalcemia prevention and management after thyroidectomy in children: A systematic review

IntroductionHypocalcemia is the most common complication following thyroidectomy in children. Guidelines to manage post-thyroidectomy hypocalcemia are available for adults, but not children. The objective of this review was to identify practices related to hypocalcemia prevention and management in pediatric patients. MethodsWe identified studies examining the prevention and management of hypocalcemia in pediatric patients post-thyroidectomy within PubMed, EMBASE, Web of Science and Cochrane databases. Three independent reviewers screened citations and reviewed full-text papers. ResultsA total of 15 studies were included, representing 1552 patients. The overall study quality was weak with lack of randomization and inconsistent outcome reporting. The pooled incidence of hypocalcemia from the 15 studies was 35.5% for transient hypocalcemia and 4.2% for permanent hypocalcemia. All studies discussed post-operative hypocalcemia treatment, with most patients requiring admission for intra-venous calcium therapy. One study described a protocol discharging asymptomatic patients on calcitriol and calcium. Three studies discussed preoperative calcium supplementation in patients at risk of hypocalcemia. No studies examined routine use of calcium and/or vitamin D supplementation to prevent post-operative hypocalcemia. ConclusionA significant number of children undergoing thyroidectomy develop hypocalcemia. Despite this high incidence, our systematic review demonstrates significant practice variation surrounding post-thyroidectomy hypocalcemia prevention and management in children. Level of EvidenceIII (systematic review of studies of which some were case–control studies (III) and some were case series (IV)).

Study of the incidence of hypocalcemia in patients undergoing bilateral thyroid surgery

Background: Thyroid surgery are among the most common operations performed all over the world. Hypocalcemia following total thyroidectomy is a fairly common complication. Occurrence of acute hypocalcemia can be predicted in patients undergoing thyroid surgery, based on serial calcium measurement and this helps in early prediction of hypocalcemia. The aim of present study was to assess the incidence of post thyroidectomy hypocalcemia and factors which might play a role in its occurrence.Methods: A total 30 patients who underwent bilateral thyroidectomy were analysed. The study period was from June 2017 to March 2019. The incidence of hypocalcemia was analysed with serial calcium estimation in immediate post-operative period, 4 hours and 24 hours after surgery and on 5th post-operative day. The factors analysed included pre-operative and post-operative serum calcium levels, clinical features, the disease type and factors related to surgery. The ethical approval was taken from the ethical committee of the institute. At the end of the study data was collected and analysed by using student t-test and chi square test. A p-value of less than 0.05 was considered significant.Results: Post-operative transient hypocalcemia developed in 21 patients out of 30 (70%). Of them six patients (28.75%) developed severe hypocalcemia and 15 (71.42%) developed mild to moderate hypocalcemia. Out of six patients, five patients were histopathologically diagnosed as malignant thyroid disease. 15 patients who developed mild to moderate hypocalcemia were diagnosed to be having benign thyroid conditions.Conclusions: Patients underwent thyroid surgery for malignant conditions showed higher incidence and severity hypocalcemia as compared to cases where surgery was performed for benign thyroid disease. This complication can be prevented with meticulous perioperative dissection, prompt identification of parathyroid glands and frequent postoperative monitoring of serum calcium levels.

Post-Thyroidectomy Hypocalcemia: Clinical Study at Tertiary Care Center.

A recent review by the American association of clinical Endocrinologist (AACE) and American College of Endocrinology discussed definations and management of post-surgical hypocalcemia. In term of post-surgical hypocalcemia a total serum calcium of less than 8.5mg/Dl(2.125mmol/L) or ionised calcium less than 1.15mmol/L were considered as cut off levels. The aim of the study is to evaluate & compare 30 operated cases of thyroid surgery based on its gender, age distribution, pre-operative indication & nature of surgery, post-thyroidectomy hypocalcemia. This prospective study was conducted in the Department of Otorhinolaryngology, head, neck surgery department sir T hospital, and government medical college Bhavnagar. All patients undergoing thyroidectomy surgeries were included in the study. Data collected from the patients undergoing thyroidectomise by meticulous history taking, careful clinical examination, appropriate radiological, haematological investigations including serum calcium and serum albumin, operative findings and follow-up of the cases was done after surgery for post- in association with nature of thyroid surgery. Post-thyroidectomy transient hypocalcemia is a frequent complication which can be prevented with pre-operative preparation of patients with extreme caution and pre-operative meticulous dissection, prompt identification of parathyroids and post-operative frequent monitoring of serum calcium and early treatment can prevent significant morbidity. operative hypocalcemia. The study was conducted to know the incidence of hypocalcemia after thyroid surgery.

The need to give calcium supplementation after total thyroidectomy.

Background: A prospective study was carried on female patients after total thyroidectomy to assess the need for calcium supplementation after surgery. Aim of work: To assess the need for routine calcium supplementation after total thyroidectomy. Patients and Methods: From 2017 to 2018, a total of 90 female patients with different thyroid disorders were conducted; thyroid cancer or previous neck surgery patients were excluded, neck ultrasound was done. Results: Study shows improvement in the level of serum calcium in the group already on supplementation. On the other hand it shows slight decrease in serum calcium level in the group without supplementation. The statistical analysis showed highly significant relationship between the Ca supplementation and hypocalcemia with P value of less than 0.05 Conclusion: Certain risk factors are associated with post-thyroidectomy hypocalcemia. Total thyroidectomy, thyroiditis and routine non calcium supplementation were found to be the main risk factors of post-thyroidectomy hypocalcemia in the present study.

Predictors of post-thyroidectomy hypocalcaemia: a systematic and narrative review.

Hypocalcaemia is the most common complication after total or completion thyroidectomy. This study assesses recent evidence on predictive factors for post-thyroidectomy hypocalcaemia in order to identify the patients affected and aid prevention. Two authors independently assessed articles and extracted data to provide a narrative synthesis. This study was an updated systematic search and narrative review regarding predictors of post-thyroidectomy hypocalcaemia using the Ovid Medline, Embase, Cochrane and Cinahl databases. Results were limited to papers published from January 2012 to August 2019. Sixty-three observational studies with a total of 210 401 patients met the inclusion criteria. The median incidence was 27.5 per cent for transient biochemical hypocalcaemia, 12.5 per cent for symptomatic hypocalcaemia and 2.2 per cent for permanent hypocalcaemia. The most frequent statistically significant predictor of hypocalcaemia was peri-operative parathyroid hormone level. Symptomatic hypocalcaemia and permanent hypocalcaemia were seen more frequently in patients undergoing concomitant neck dissection. Many factors have been studied for their link to post-thyroidectomy hypocalcaemia, and this study assesses the recent evidence presented in each case.