Post-thyroidectomy Hypocalcemia Research Articles

PREVALENCE AND PATHOPHYSIOLOGY OF POST-THYROIDECTOMY HYPOCALCAEMIA

Post-thyroidectomy hypocalcemia is a recognised and potentially significant complication arising from the surgical removal of the thyroid gland. The study's main objective is to find the prevalence and pathophysiology of post-thyroidectomy hypocalcemia. This prospective observational study was conducted in Civil Hospital Quetta from June 2021 to July 2022. A total of 162 patients undergoing thyroidectomy for various indications, including thyroid cancer, hyperthyroidism, and goiter, were enrolled in the study. Before surgery, baseline data were gathered, including demographic information, medical history, and preoperative serum calcium and parathyroid hormone (PTH) levels, from the 162 enrolled patients scheduled for thyroidectomy. Data were collected from 162 patients from both genders. The mean age of patients was 48.5 ± 8.2 years, with 70% female. The diagnoses included 40% with thyroid cancer, 30% with hyperthyroidism, and 30% with a large goiter. Preoperative serum calcium levels were 9.0 ± 0.5 mg/dL, parathyroid hormone (PTH) levels were 45 ± 9.80 pg/mL, and vitamin D levels were 25.5 ± 6.3 ng/mL. A history of hypocalcemia was noted in 5% of the participants. The mean serum calcium level was 9.0 mg/dL, with a standard deviation of 0.5. However, at 48 hours post-op, there was a decrease in the mean serum calcium level to 7.8 mg/dL, with a standard deviation of 0.7. It is concluded that the interaction between reduced serum calcium and parathyroid hormone levels highlights the immediate impact of surgery on calcium homeostasis.

Early hospital discharge through prediction of post-thyroidectomy hypoparathyroidism

IntroductionHypoparathyroidism is the most common postsurgical complication of total thyroidectomy. Furthermore, it is the main cause of prolonged hospitalisation after this procedure. ObjectiveTo predict the probability of post-thyroidectomy hypocalcaemia according to the levels of intact parathyroid hormone (iPTH), as well as to determine the needs for treatment with exogenous calcium according to the levels of serum calcium (Ca). Materials and methodsRetrospective study was carried out on patients who underwent total thyroidectomy between January 2017 and January 2020 at Los Arcos del Mar Menor University Hospital (HULAMM). iPTH and Ca levels ​​were measured at 4, 24 and 48 h after the surgery. Follow-up was 6 months. ResultsNinety-four patients were operated on. Temporary and permanent postoperative hypoparathyroidism percentages were, respectively, 51.06% and 6.38%. iPTH level 24 h after the procedure was the most reliable predictor of post-thyroidectomy temporary hypoparathyroidism (Area Under the ROC Curve (AUC) = 0.933, p < .001). iPTH levels ​​≥29 pg/mL predicted normal parathyroid metabolism. ConclusionsThe combined values of iPTH and Ca levels 24 h after thyroidectomy seems to be a reliable, safe and efficient method to control the post-thyroidectomy hypoparathyroidism. Our protocol could reduce the hospital stay of patients at low risk of hypocalcaemia, allowing them to be discharged from the hospital on the first postoperative morning and identifying patients at high risk of hypocalcaemia early.

Comparison of indocyanine green angiography vs intraoperative parathyroid hormone in early prediction of risk of post-thyroidectomy hypocalcemia: a prospective cohort study

Introduction: Indocyanine green (ICG) angiography is the ‘real-time intraoperative imaging’ technique used to reduce the chances of hypoparathyroidism in post-thyroidectomy patients. In our study, the authors predicted the risk of early post-thyroidectomy hypocalcemia by intraoperative evaluation of parathyroid gland perfusion by ICG angiography. Materials and methods: In patients who underwent total thyroidectomy, ICG angiography was done using the SPY PHI imaging system (Stryker). Post-thyroid specimen removal, scoring of parathyroids was done in spy contrast mode. All 4 or &lt;4 visualized parathyroids were scored for vascularity with the highest score of 8. Serum ionized calcium was done 6 h postsurgery and on the morning and evening of postoperative days 1 and 2. Calcium supplements were given to only those who developed clinical or severe biochemical hypocalcemia. Results: Out of 60, postoperative hypocalcemia was noted in 41 patients. Total ICG score ≤5 was seen in 34 patients, out of which 28 developed postoperative hypocalcemia showing PPV 82.3% and diagnostic accuracy of 68.3% while iPTH (4.28 pmol/l) showed PPV 76.7 and diagnostic accuracy 70 %. In eight patients, none of the glands was scored as 2 (White) and all these patients developed hypocalcemia requiring calcium infusion. Conclusion: The absence of visualization of at least 1 well-perfused (score 2) gland on ICG angiography is highly predictive of hypocalcemia and the majority of patients with total ICG score ≤5 developed hypocalcemia in the immediate postoperative period. ICG is a good predictor of the absence of hypoparathyroidism after thyroidectomy and is comparable to iPTH in the prediction of post-thyroidectomy hypocalcemia.

Post-thyroidectomy hypocalcemia in Saudi Arabia: a review of incidence rates and risk factors

Post-thyroidectomy hypocalcemia is a frequent and variable complication in Saudi Arabia, which can extend hospital stays and raise healthcare costs. A systematic search was performed using databases for studies published before January 2024 documenting hypocalcemia rates in Saudi Arabian adults following thyroidectomy. Eighteen studies met our criteria, encompassing 3,455 patients. The analyses revealed substantial variability across included studies in terms of sample size, design, and reported hypocalcemia rates. Overall rates ranged from 0.07% to 67.4% (averaging 24.4%), with transient cases being more prevalent (averaging 26.8%). Permanent hypocalcemia rates were lower (averaging 1.3%, ranging from 0% to 3.7%). Preoperative and postoperative parathyroid hormone (PTH) levels consistently predicted hypocalcemia. Additional potential contributing factors included the number of parathyroid glands (PGs) identified during surgery, gender, pre-surgical hyperthyroidism, and surgical expertise and experience. These findings translate to several implications for surgical practice and patient management. Close monitoring of PTH levels holds significant importance. Selective identification of PGs during surgery might decrease the risk of hypoparathyroidism. In addition, surgeon training and supervision are pivotal for achieving optimal outcomes. Identifying patients at risk for hypocalcemia early might facilitate earlier discharge. In conclusion, post-thyroidectomy hypocalcemia poses a variable and widespread complication in Saudi Arabia. Comprehending its risk factors and implementing targeted strategies have the potential to improve patient management and outcomes.

Comparison of Perioperative Outcomes in Patients with Graves' Disease Undergoing Total Thyroidectomy With or Without Near Infrared Autofluorescence Imaging.

Background: The impact of near-infrared autofluorescence (NIRAF) imaging on postthyroidectomy hypocalcemia is controversial. As patients with Graves' disease are at increased risk, our aim was to compare postoperative parathyroid function in these patients undergoing total thyroidectomy (TT) with or without NIRAF imaging. Methods: This was a retrospective "before and after" study, comparing outcomes of patients who underwent TT without or with NIRAF imaging at a single center. Primary outcome was the incidence of temporary hypocalcemia and secondary outcomes, rates of incidental parathyroidectomy on final specimens and permanent hypocalcemia. Analyses were performed using Mann-Whitney U and chi-Square tests. Continuous data are expressed as median (interquartile range). Results: There were 85 patients in NIRAF and 100 patients in non-NIRAF group. Groups were comparable regarding age, gender, body-mass index, and thyroid weight. Number of parathyroid glands identified intraoperatively was 3 in both groups (p = 0.47). Intraoperative parathyroid implantation rate was 16.5% in NIRAF and 6% in non-NIRAF group (p = 0.02). Incidental parathyroidectomy rate on final pathology was 12.9% in NIRAF and 32% in non-NIRAF group (p = 0.002). The rates of temporary (11.7% vs. 16%) and permanent hypocalcemia (2.4% vs. 2%) were similar between the two groups, respectively (p = 0.66). Conclusion: To our knowledge, this is the first comparative study investigating the impact of NIRAF on postoperative parathyroid function after thyroidectomy for Graves' disease. The rate of incidental parathyroidectomy on final pathology was lower with use of NIRAF, without an impact on temporary or permanent hypocalcemia rates compared to conventional technique.

Relationship of Post-Thyroidectomy Hypocalcemia to Surgeon’s Experience in a Private Tertiary Hospital

Objective:To determine the association of surgeon’s experience based on years of practice and incidence of post thyroidectomy hypocalcemia. Methods: Design: Retrospective cohort studySetting: Tertiary Private Training HospitalParticipants: Records of patients who underwent total thyroidectomy in a private tertiary hospital from January 2003 to December 2018 were retrospectively reviewed. Medical information obtained were patient demographics, surgeon’s years of practice, thyroid specimen weight, technique of surgery, histopathologic findings and calcium assay values. Chi square test and Odds Ratio analysis were used to determine the relationship between the surgeon’s experience and post-thyroidectomy hypocalcemia. Results:Three hundred fourteen (314) patients who underwent total thyroidectomy from 2003 to 2018 were included in the study. Overall rate of post-operative hypocalcemia was 41%. On multivariate analysis, no significant odds ratio was found between surgeons with 5 to 19 years of experience and those with more than 19 years of experience in relation to post-operative hypocalcemia [Odds Ratio 1.4 (95% Confidence Interval 0.7 to 2.6)]. Odds ratios for other variables may be interpreted, however, they could not be generalized over the population where data was gathered since the 95% Confidence Interval includes 1. Conclusion: The results of this retrospective cohort study suggest that post-thyroidectomy hypocalcemia is not associated with surgeon’s experience based on years of practice. Further studies are recommended in a multicenter approach to better generalize to the whole population.

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.

A symptom-based algorithm for calcium management after thyroid surgery: a prospective multi-center study.

Evidence based treatment guidelines for the management of post-thyroidectomy hypocalcemia are absent. The aim of this study was to evaluate a newly developed symptom-based treatment algorithm including a protocolized attempt to phase out supplementation. In a prospective multicenter study, patients were treated according to the new algorithm and compared to a historical cohort of patients treated with a biochemically-based approach. The primary outcome was the proportion of patients receiving calcium and/or alphacalcidol supplementation. Secondary outcomes were calcium-related complications and predictors for supplementation. 134 patients were included prospectively, and compared to 392 historical patients. The new algorithm significantly reduced the proportion of patients treated with calcium and/or alphacalcidol during the first postoperative year (OR 0.36 [95% CI 0.23 - 0.54], p<0.001), and persistently at 12 months follow-up (OR 0.51 [0.28 - 0.90], p<0.05). No severe calcium-related complications occurred, even though calcium-related visits to the emergency department and readmissions increased (OR 11.5 [4.51 - 29.3], p<0.001) and (OR 3.46 [1.58 - 7.57], p<0.05), respectively. The proportional change in pre- to postoperative parathyroid hormone (PTH) was an independent predictor for supplementation (OR 1.04 [1.02 - 1.07], p<0.05). Symptom-based management of post-thyroidectomy hypocalcemia and a protocolized attempt to phase out supplementation safely reduced the proportion of patients receiving supplementation, although the number of calcium-related hospital visits increased. For the future, we envision a more individualized treatment approach for patients at risk for delayed symptomatic hypocalcemia, including the proportional change in pre- to postoperative PTH.

Meta-Analysis of Predictors of Post-Thyroidectomy Hypocalcaemia

Abstract Background Hypocalcaemia is common after thyroidectomy. Accurate prediction and appropriate management may help reduce morbidity and hospital stay. The aim of this study was to perform a systematic literature review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Patients and Methods A systematic search of PubMed and the Cochrane Library databases was undertaken, and the evaluation of titles, abstracts, eligibility and quality of studies. Results 11 articles were included. Clinical predictors that had a significant association with post thyroidectomy hypocalcemia include female patients [OR = 0.625, 95% CI (0.420–0.932), p-value = 0.021], patients who did autotransplantation [OR = 2.020, 95% CI (0.968–4.215), p-value = 0.061] and patients who did cervical LN dissection [OR = 1.680, 95% CI (1.054–2.679), p-value = 0.029]. Clinical predictors that had higher insignificant association with post thyroidectomy hypocalcemia include patients with Graves' disease [Odds ratio (OR) = 1.054, 95% CI (0.623–1.784), p-value = 0.844], patients with more than two parathyroid glands preserved [OR = 1.131, 95% CI (0.259–4.939), p-value = 0.870] and patients who did not undergo reoperation [OR = 0.963, 95% CI (0.594–1.563), p-value=0.879]. Conclusion Clinical predictors of post Thyroidectomy hypocalcaemia include female sex, autotransplantation and cervical LN dissection.

Impact of Hypomagnesemia on Post-Thyroidectomy Hypocalcaemia

Abstract Background Total thyroidectomy is the treatment of choice for many thyroid diseases. The most common metabolic complications are disorders of calcium ion concentrations. In this study we aimed to determine the incidence of hypomagnesemia after total thyroidectomy and to investigate whether hypomagnesemia after thyroidectomy has any impact on post-thyroidectomy hypocalcemia. Patients and Methods This study was a prospective analytical one done between July 2019 and July 2020 including fifty patients who underwent total or completion thyroidectomy. Our patients were divided according to adjusted serum calcium levels of day one postoperative and clinical manifestations of hypocalcemia into 2 groups, group (A) for normocalcemic patients (clinical and biochemical) and group (B) for hypocalcemic patients (clinical or biochemical). And each group was subdivided into two subgroups according to serum magnesium levels (normomagnesemia and hypomagnesemia). Results These results cleared that, postoperative biochemical hypocalcemia was detected in 36% of cases and hypomagnesemia was detected in 62%, from the hypocalcemic group there were 88.8% with hypomagnesemia while in the normocalcemic group, there were 46.8% with hypomagnesemia. In the postoperative period 24% of patients had manifestations of clinical hypocalcemia; all of these patients (100%) had biochemical hypocalcemia. All of the cases (100%) with symptomatic hypocalcemia had low serum magnesium levels while as for the patients with only biochemical hypocalcemia, 66 % had hypomagnesemia. Conclusion Our results concluded that, regarding the correlation between calcium and magnesium, there was a statistically highly significant positive correlation between calcium and magnesium in the first day postoperative of thyroidectomy. Post-thyroidectomy hypomagnesemia was found to be a good predictor of postoperative biochemical hypocalcemia and is closely related to the clinical manifestations of hypocalcemia. So, correction of both hypomagnesemia and hypocalcemia is necessary for prompt resolution of symptoms of refractory hypocalcemia after total thyroidectomy.

Management of hypocalcemia following thyroid surgery in children.

Pediatric post-thyroidectomy hypocalcemia management varies significantly from hospital to hospital. The current study has two aims: first, we evaluate demographic data in all pediatric patients submitted to thyroid surgery in our Spanish tertiary hospital over 20 years; secondly, we describe the way that hypocalcemia was diagnosed and treated in that period and present a multidisciplinary protocol for perioperative management of this condition. This is a retrospective and observational study of all patients from 0 to 16 years old who underwent thyroid surgery from 2000 to 2020 at our institution. Demographic, surgical and electrolyte data were recorded from the electronic database. From 2000 to 2016, pediatric thyroid surgery at our institution was performed on 33 patients without a consistent approach or standard electrolyte management. A protocol for perioperative management of these patients was introduced in 2017, and applied to 13 patients. In 2019, the protocol was assessed and updated following a case of symptomatic hypocalcemia. From 2000 to 2016, 47 pediatric patients in all underwent thyroid surgery. We registered eight asymptomatic hypocalcemias. One child developed symptomatic hypocalcemia. Two patients have permanent hypoparathyroidism. Our incidence of general complications following thyroidectomy was low; hypocalcemia was the most prevalent. All the cases of hypocalcemia submitted to the protocol were identified early by iPTH measurements. Intraoperative iPTH levels and percentage drop from baseline could help stratify patients according to their risk of hypocalcemia. High risk patients require immediate postoperative supplementation, including calcitriol and calcium carbonate.

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...

Hypomagnesemia in Post Thyroidectomy Patient: An Underestimated Entity.

In post thyroidectomy patients hypocalcemia is one of the known complication many factors play important role in calcium hemostasis and magnesium is one among them. So this study was conducted to assess the prevalence of hypomagnesemia in post thyroidectomy patients and its relationship with calcium homeostasis. A prospective observational study was conducted among 31 patients who underwent total thyroidectomy or completion thyroidectomy over a period of 1 year. Patient's pre-operative and post-operative day 1 and day 2 serum calcium, magnesium and iPTH was recorded and their correlation was analyzed using SPSS 21.0. and p value of < 0.05 was taken as statistically significant. Calcium supplementation was only given to patients who developed symptomatic hypocalcemia in postoperative period. In our study hypomagnesemia in post thyroidectomy patients on post -operative day 1 and day 2 was 71% and 74.2% respectively. Hypocalcemia was seen in 64.5% of patients on post-operative day 1 and 96.8% on post-operative day 2. Symptomatic hypocalcemia was seen in 22.6% of study population on post-operative day 1 and 22.6% of patients on post-operative day 2 while 25.8% patients newly developed symptoms of hypocalcemia. Statistically significant correlation was found between calcium and magnesium levels in post op day 1(< 0.001) and post op day 2(< 0.004) and also statistically significant correlation was found between post-operative day 1 magnesium levels and post-operative day 2 calcium levels (0.001). Symptomatic hypocalcemia was more commonly seen among patients who had hypomagnesemia along with hypocalcemia though it failed to show any statistical significance. Post thyroidectomy hypomagnesemia is frequent event and magnesium acts as an independent risk factor in development of post thyroidectomy hypocalcemia. Hypomagnesemia tends to alleviate symptomatic hypocalcemia in post thyroidectomy patients. So the role of magnesium correction to alleviate severe hypocalcemia needs to be further studied.

Relative efficacy of prophylactic strategies for postthyroidectomy hypocalcemia: a systematic review and network meta-analysis.

Routine prophylaxis for at-risk patients may reduce the occurrence of postoperative hypocalcemia but is not widely adopted due to a lack of evidence on the efficacy of available prophylactic strategies. In this study, we compared the relative efficacy of prophylactic strategies for postthyroidectomy hypocalcemia with a systematic review and network meta-analysis. PubMed, Embase, and Cochrane Library were searched, covering the period from 1980 to May 2022, for randomized controlled trials (RCTs) comparing calcium, vitamin D 3 , activated vitamin D 3 , teriparatide, steroids, and magnesium with placebo or each other in patients receiving total or completion thyroidectomy. Involved RCTs reporting symptomatic or biochemical hypocalcemia. The primary outcome was symptomatic hypocalcemia, defined as circumoral tingling, and Chvostek and Trousseau signs. The secondary outcome was biochemical hypocalcemia. Risk of bias was assessed using the Cochrane risk of bias assessment tool for randomized trials. Pooled estimates were calculated using a random-effects inverse-variance weighting model. The network meta-analysis was performed under the frequentist framework. This meta-analysis was registered on the PROSPERO (International prospective register of systematic reviews) (CRD42022299982). Twenty-seven RCTs comprising 3382 patients are included. Prophylactic strategies of teriparatide, oral calcium plus vitamin D 3 , and oral calcium plus activated vitamin D 3 are superior to placebo in reducing symptomatic hypocalcemia. Teriparatide emerged as the most effective strategy for symptomatic hypocalcemia [relative risk (RR): 0.18; 95% CI: 0.03-0.98], followed by oral calcium plus activated vitamin D 3 (RR: 0.42; 95% CI: 0.25-0.73) and oral calcium plus vitamin D 3 (RR: 0.43; 95% CI: 0.26-0.71). Evidence on monotherapy with either oral calcium or vitamin D 3 in reducing symptomatic hypocalcemia is insufficient. Intravenous calcium and oral calcium are effective in reducing biochemical hypocalcemia. This network meta-analysis provides information on the relative efficacy of current prophylactic strategies for postthyroidectomy hypocalcemia. Teriparatide performed better than other interventions and would seem appropriate for deployment among high-risk populations.

Post Total Thyroidectomy Hypocalcaemia and relation with the Age of the Patient

Objective: To find the magnitude of clinically overt hypocalcaemia post-total thyroidectomy and its relation with the age of the patient.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Combined Military Hospital, Bahawalpur Pakistan, from Jan 2017 to Dec 2019.&#x0D; Methodology: Sixty patients who were to undergo total thyroidectomy were included in the study in strict compliance with the inclusion and exclusion criteria. Patients were divided into two groups according to their ages. In Group-A, patients younger than 50 and Group-B, patients older than 50 years were included. All the patients were followed up by clinical examination for the development of clinically overt hypocalcaemia and confirmed by measurement of serum calcium.&#x0D; Results: Mean age of the patients was 42.75±13.05 years, with an age range of 20 to 68 years. Of all the patients, 14(23.3%) were male, and 46(76.7%) were females. Seven patients in Group-A developed post-thyroidectomy hypocalcaemia clinically,whereas, in Group-B, only one developed this condition. Clinical post-thyroidectomy hypocalcaemia developed more often in the younger age group and these results were statistically significant (p= 0.023).&#x0D; Conclusion: Clinically overt hypocalcaemia develops more often in younger patients after total thyroidectomy.Keywords: Biochemical hypocalcaemia, Clinical hypocalcaemia, Post thyroidectomy hypocalcaemia, Total thyroidectomy

Frequency of Post-Surgery Hypocalcaemia in Patients Undergoing Total Thyroidectomy

Objective: To find out frequency of post-thyroidectomy hypocalcaemia among patients undergoing total thyroidectomy. Study Design: A prospective cohort study. Place and Duration: The Department of ENT, Shahida Islam Teaching Hosptial, Lodhran from January 2021 to December 2021. Methodology: A total of 181 patients of both genders aged 12-65 years with multinodular goiter, carcinoma thyroid or recurrent goiter and who were indicated total thyroidectomy were included. At the time of enrollment, demographic characteristics like gender, age and residential status were noted. Pre-surgery thyroid profile and serum calcium were measure from institutional laboratory. Standard procedure protocols were followed for total thyroidectomy. Post-surgery, measurement of serum calcium level was done after 24-hours and serum calcium level&lt;8.0 mg/dL was labeled as hypocalcaemia. Results: In a total of 181 patients as per inclusion/exclusion criteria who underwent total thyroidectomy, 137 (75.7%) were female. Mean age was 43.6+8.2 years while 113 (62.4%) patients were aged between 40-60 years. Residential status of 98 (54.1%) patients was rural. Pre-surgery diagnosis was malignant in 41 (22.7%) patients while it was benign in 140 (77.3%) patients. Post-thyroidectomy hypocalcaemia was noted in 59 (32.6%) patients. Female gender (p=0.0251) and baseline hypertension (p=0.0287) were found to have significant association with post-thyroidectomy hypocalcaemia. Clinical Implications: Following patients of hypocalcaemia would certainly give us information about the proportion of transient hypocalcaemia and permanent hypocalcaemia. Conclusion: Frequency of post-thyroidectomy hypocalcaemia was found to be high (32.6%). Female gender and baseline hypertension were found to have significant association with post-thyroidectomy hypocalcaemia. Keywords: Calcium, carcinoma thyroid, hypertension, hypocalcaemia, multinodular goiter, thyroidectomy.

Prevalence and Outcome of Post- thyroidectomy Hypocalcaemia: A Prospective Clinical Study

Aims: (1) To record the incidence of post-thyroidectomy hypocalcaemia. (2) To correlate blood calcium levels with symptoms of hypocalcaemia. (3) To find out the type of hypocalcaemia whether temporary or permanent. (4) To assess the risk factors for development of hypocalcaemia. Design: Prospective analysis of 50 consecutive patients undergoing thyroid surgeries. Materials &amp; Method: All patients undergoing any thyroidectomy in the department of general surgery were followed for a period of 3 months. The type of surgery, Histopathology and clinical diagnosis to predict the outcome of post-operative hypocalcaemia was validated. The influences of Patient factors, intra-operative identification of RLN and parathyroid were also observed. Results: The overall prevalence of hypocalcaemia was 28% of which 12 patients had temporary and 2 had permanent hypocalcaemia. Only 12 patients developed clinical symptoms. Hypocalcaemia typically ensues during the early post-operative period (24-48 hrs). Hypocalcaemia was significantly associated with the type of surgery (p=0.0293), Histopathology (p=0.0312) and clinical diagnosis (p=0.0008). Age, Sex and identification of RLN and Parathyroid did not play a significant role in predicting the outcome of post-operative hypocalcaemia. Conclusion: Hypocalcaemia either transient or permanent can be debilitating and lead to significant morbidity. Temporary hypocalcaemia is common after surgery for malignancies. Histopathology, clinical diagnosis and extent of surgical resection influence the outcome of hypocalcaemia. Early measurement of serum calcium and albumin levels can ensure early management and prevent complications of hypocalcaemia.

Post-thyroidectomy hypocalcemia and related complications

The incidence of post-thyroidectomy hypocalcemia is high while the factors involved include age (&gt; 50 years), type of operation, operative time, neck dissection, histology of the surgical specimen and vocal fold paralysis. Low ionic calcium concentrations are indicative of the presence of symptoms of hypocalcemia and the need for oral calcium. Progression to definitive hypoparathyroidism occurs only in patients with clinical manifestations of post-thyroidectomy hypocalcemia. In general, the problem with post-surgical hypoparathyroidism resides in the surgical procedure itself. The most common are related to neuronal hyperexcitability, which explains the paresthesias, cramps and numbness, which usually start in the perioral region and on the fingertips. Muscle spasms and muscle stiffness are also common. When severe, hypocalcemia can lead to life-threatening spastic tetany, laryngospasm, and seizures. The current manuscript aimed to present a review of the bibliography on thyroidectomy and negative impact of its complications on human health, mainly because of a higher risk for developing hypocalcemia. To achieve the study goal, this review covered most recent published articles from 2017 onward.

Critical Analysis of the Frequency and Factors Leading to Hypocalcemia after Total/ Near Total Thyroidectomy

Objective: To critically analyze the frequency and factors leading to hypocalcemia in Total/ Near Total thyroidectomy Methods: This descriptive case series study was conducted over period of one year by taking sample of 138 patients of simple multinodular goiter or carcinoma of thyroid who underwent total/near total thyroidectomy and patients who had serum calcium &lt;8mg/dl postoperatively. Recurrent thyroid surgery or patients undergoing lobectomy were excluded from the study. SPSS version 21 was used for data analysis. Mean ± SD represent the continuous variables &amp; frequencies/ percentages represent the quantitiave results. Chi-square test was applied to analyze effect modification. P value &lt;0.05 was taken as significant. Study was approved by the ethical review committee of the SMBBMU - Larkana. Results: The mean ± SD age of patients was 39.86 ± 11.5 years with a range from 22 to 60 years. The mean ± SD serum Pre-operative calcium was 9.64 ± 0.44 mg/dL. Post thyroidectomy) values of serum calcium were noted as mean ± SD 7.68 ± 2.11 mg/dL. Sixty five percent (n =90) of all patients were females. NTT- were 67.4% (n = 93) while TT- 32.6% (n = 45). Frequency of hypocalcemia was 28.3% (n = 39). More patients after TT developed hypocalcemia (44.4%) than NTT (20.4%) P value = 0.004). Old age, female gender, surgery for thyroid cancer and patient with lower preoperative serum calcium had a higher frequency of hypocalcemia after thyroidectomy. Practical implication Conclusion:The frequency of post thyroidectomy hypocalcemia in this study is 28.3%. Post thyroidectomy hypocalcemia is associated with both NTT and TT, however the frequency is more common (more than twice) after TT. Factors like old age, female gender, patients having thyroid cancer and having lower serum calcium preoperatively are strong effect-modifiers. Keywords: Total thyroidectomy. Near total thyroidectomy,Calcium, Hypocalcemia, .Parathyroid hormone.

Incidence of hypocalcemia in total thyroidectomy

Background and objectives: Hypocalcemia is a common complication in patients after total thyroidectomy. This study was undertaken to identify risk factors for post thyroidectomy hypocalcemia. To evaluate the risk factors of post total thyroidectomy hypocalcemia, in order to enable early management, avoid complications, and treat accordingly. Method: A longitudinal study was performed from January 2019 to February 2022. All cases of total Thyroidectomy were included which totaled 27. Ionized serum calcium with Parathyroid Hormone, serum, magnesium, serum phosphate and vitamin D were all measured for every patient preoperatively then postoperatively once, and serum calcium was measured every eight hours for the first 48 hours. Results: Our results showed an overall significant difference in the readings of calcium at different times, the mean of pre-operative reading of serum calcium was (9.6 mg/dl), which was greater than the mean of calcium measured 24 hours post-operative that was (8.72 mg/dl) with (p &lt; 0.001), and the incidence of hypocalcemia was 51.9% of hypocalcemia after total thyroidectomy. Parathyroid Hormone level was the only risk factor for developing post total thyroidectomy hypocalcemia (p &lt; 0.001), other risk factors were none of them significant.