Postoperative Hypocalcemia Research Articles

Factors associated with postoperative hypocalcemia following thyroidectomy in childhood.

Postoperative hypocalcemia is a frequent complication after thyroidectomy. Hypoparathyroidism may develop as transient (TtHP), with normalization within six months from surgery, or permanent (PtHP) if the patient requires replacement therapy. We analyzed factors associated with the development of postoperative hypoparathyroidism and in detail PtHP following thyroid surgery in a pediatric population. A retrospective multicenter study analyzing 326 patients was carried out. We recorded gender, age, tumor size, thyroiditis, extrathyroidal extension, lymph node dissection (central/lateral compartment, unilateral/bilateral), parathyroid autotransplantation, and histology. Additionally, calcium levels were acquired postoperatively. We analyzed pediatric patients ≤18 years who underwent thyroidectomy clustered into age groups (≤15 or>15). Patients' mean follow-up was 5.8 years (1-11 years). Postoperative hypoparathyroidism occurred in 36 (11.0%): 20 cases (6.13%) developed PtHP. Postoperative hypoparathyroidism was more frequent in younger patients (P=0.014), in larger tumors (P<0.001), in case of extrathyroidal extension (P=0.037), and in central compartment (P=0.020) and bilateral lymph node dissection (P=0.030). PtHP was more frequent in older patients (P=0.014), in case of thyroiditis (P<0.001), and extrathyroidal extension (P<0.001). Concerning the first postoperative calcium level measurement, in the postoperative hypoparathyroidism group, we registered a 8.17mg/dL value with 14% pre/postoperative decrease (ΔCa ), whereas in PtHP patient group calcium level was 7.91mg/dL with 16.7% ΔCa . The risk of postoperative hypoparathyroidism is related to younger age, tumor size, central compartment and bilateral lymph node dissection, extrathyroidal extension, and decrease in postoperative calcium levels. The risk of PtHP is related to older age, thyroiditis, extrathyroidal extension, and decrease in postoperative calcium levels.

A single-center experience of parathyroidectomy in 1500 cases for secondary hyperparathyroidism: a retrospective study

Background Chronic kidney disease (CKD) is a global public health problem. With the deterioration of renal function, a certain proportion of CKD patients enter the uremic stage, and secondary hyperparathyroidism (SHPT) becomes a challenge. For refractory hyperparathyroidism, parathyroidectomy (PTX) plays a key role in reducing mortality and improving prognosis. Nevertheless, no consensus has been reached on the optimal surgical method. We aimed to provide evidence for the effectiveness of surgical treatment by summarizing the experience from our center. Methods Clinical data from 1500 patients undergoing parathyroidectomy were recorded, which included 1419 patients in a total parathyroidectomy without autotransplantation (tPTX) group, 54 patients in a total parathyroidectomy plus autotransplantation (tPTX + AT) group, and 27 patients in the other group. Perioperative basic data, intact parathyroid hormone (i-PTH) levels, serum calcium levels, serum phosphorus levels, pathological reports, coexisting thyroid diseases, short-term outcomes and complications were analyzed. Moreover, postoperative complications were compared between the tPTX and tPTX + AT groups. Results Parathyroid hormone, serum calcium and phosphorus levels decreased significantly post-surgery. Two patients died during the perioperative period. As the two most common complications, the incidences of severe hypocalcemia and hyperkalemia were 36.20% (543 cases) and 24.60% (369 cases), respectively. Pre-iPTH levels (OR = 1.001, 95% CI: 1.001–1.001, p < 0.01), serum alkaline phosphatase (ALP) levels (OR = 1.002, 95% CI: 1.001–1.002, p < 0.01) and the mass of excised parathyroid gland (OR = 3.06, 95% CI: 1.24–7.55, p = 0.02) were positively associated with postoperative severe hypocalcemia, while age and serum calcium were negatively associated with it. Pathological reports of resected parathyroid and thyroid glands indicated that 96.49% had parathyroid nodular hyperplasia, 13.45% had thyroid nodular hyperplasia, and 4.08% had thyroid papillary carcinoma. Conclusions Parathyroidectomy is a safe and effective treatment for refractory secondary hyperparathyroidism. Severe hypocalcemia is the main complication, and coexistent thyroid diseases should never be neglected.

Does preoperative vitamin D deficiency delay recovery time from transient hypocalcemia after thyroidectomy?

Aim: To investigate the relationship between preoperative vitamin D deficiency and the recovery/healing time from postoperative hypoparathyroidism or hypocalcemia.&#x0D; Material and Method: The sample consisted of patients that underwent thyroidectomy and preoperative 25-hydroxy-vitamin D analysis between 2014 and 2018 at the General Surgery Clinic of Health Sciences University Ankara Numune Training and Research Hospital. Of the 1598 patients who underwent total thyroidectomy, 73 were included in the study. These patients were selected from 214 patients who developed postoperative hypocalcemia. The patients’ demographic characteristics, surgical indications, operative findings, postoperative pathology results, preoperative and postoperative biochemical parameters and clinical outcomes were retrospectively obtained from the electronic records. &#x0D; Results: Of the 73 patients included in the study, 10 (13.7%) were male and 63 (86.3%) were female. Preoperative vitamin D level was normal in 16 patients and deficient in 57. The patients were divided into two groups: Group 1 with normal preoperative vitamin-D levels and Group 2 with vitamin D deficiency. There was no statistically significant difference between Groups 1 and 2 in terms of parathormone (months 1, 2 and 3) and calcium levels (p&gt;0.05); however, preoperative vitamin D levels statistically significantly differed between the two groups.&#x0D; Conclusion: Our study suggests that having a normal level of vitamin D or deficiency does not have significant effect on the recovery time from hypocalcemia after thyroidectomy. Therefore, we consider that it is not necessary to measure vitamin D in routine preoperative screening or apply a vitamin D replacement.

Surgeon perceptions of volume threshold and essential practices for pediatric thyroidectomy✰

IntroductionThe topics of sub-specialization and regionalization of care have garnered increased attention among pediatric surgeons. Thyroid surgeries are one such sub-specialty and are commonly concentrated within practices. A national survey was conducted examining current surgeon practices and beliefs surrounding pediatric thyroid surgery. MethodsNon-resident members of the American Pediatric Surgical Association (APSA) were surveyed in October 2020. Respondents were stratified based on self-reported thyroid surgical experience. Those who performed thyroid surgery were asked about surgical technique and operative practices; those who did not were asked about referral patterns. All respondents were asked about perceptions surrounding the volume-outcome relationship for pediatric thyroid surgery. ResultsAmong 1015 APSA members, 405 (40%) responded, with 79% (317/400) practicing at academic hospitals, 58% (232/401) practicing in major metropolitan area, and 41% (161/392) with over 10 years of attending pediatric surgery experience. Most respondents (88%, n = 356) agreed that thyroid surgery volume affects outcome, though wide variation was reported in the annual case threshold for “high volume” surgery. Eighty-four respondents (21%) reported performing ≥ 1 pediatric thyroid surgery in the past year. Of these, 82% routinely use recurrent laryngeal nerve monitoring, 32% routinely send hemithyroidectomy patients home the same day, and there was little consensus surrounding postoperative hypocalcemia management. The majority of respondents endorse performing thyroid procedures with a colleague. ConclusionsPediatric thyroid surgery appears to be performed by a subset of active pediatric surgeons, most of whom endorse the use of a dual operating team. More evidence is needed to build consensus around additional perioperative practices.

Outcome of Parathyroidectomy for Renal Hyperparathyroidism: A Single Center Experience

Background: Renal hyperparathyroidism (HPTH) is a common complication of chronic kidney disease and is known to cause significant morbidity in these patients. There has been substantial debate on the best possible treatment of this condition. Surgical treatment is now considered to be of vital importance as its efficacy is well documented. The present study reported the outcome of parathyroidectomy in King Chulalongkorn Memorial Hospital, a university hospital in Bangkok, Thailand. Objective: To determine surgical outcomes, including success rate and perioperative complications of parathyroidectomy in patients with renal HPTH. Materials and Methods: The data was collected by retrospective review of patients’ records between June 2014 and May 2019. One hundred ten patients were enrolled. Their demographic data, laboratory results, and outcomes were collected and categorized. Results: Among 110 patients, men accounted for 48.6%. The mean age was 49.5 years (SD 13.3). The most frequent operation was total parathyroidectomy with autotransplantation (TPTX+AT). All four glands were identified and excised in 84.5% of all patients. The mean preoperative serum intact parathyroid hormone (iPTH) level was 1,938 pg per dL with a range of 171 to 5,000 pg per dL. Postoperative hypocalcemia requiring intravenous calcium supplement was present in 70%. Postoperative cardiovascular complication occurrences were 16.4%, with one mortality due to myocardial infarction. In addition, one patient suffered unilateral recurrent laryngeal nerve injury, while two had stroke. The overall success rate of treatment was 81.1%, with 7.3% and 8.2% of patients that had persistently high PTH and recurrence of HPTH, respectively. Conclusion: Parathyroidectomy is an essential choice of treatment in patients with renal HPTH. Further validation of correlations with other factors is now being processed, and more data are needed. Keywords: Secondary hyperparathyroidism; Tertiary hyperparathyroidism; Chronic kidney disease mineral bone disease; Parathyroidectomy

The Influence of Prophylactic Calcium and Magnesium Supplementation on Postoperative Quality of Life and Hypocalcemia After Total Thyroidectomy: Study Protocol for a Randomized Controlled Trial.

Background: We want to investigate if a routine preoperative dietary supplementation of calcium and magnesium prior to thyroidectomy for nodular goiter and graves' disease can influence patients' outcome with regards to hypocalcemia associated symptoms and quality of life in order to reduce the risk of post-thyroidectomy hypocalcemia and to improve patient's quality of life.Methods: The study will be conducted as a two-armed randomized controlled trial including patients scheduled for total thyroidectomy. Patients assigned to the intervention group will receive calcium carbonate and magnesium oxide starting 2 weeks preoperatively. Primary outcome is the postoperative quality of life measured by the ThyPRO-39 and EQ-5D questionnaires. Secondary outcome is the assessment of postoperative biochemical (calcium and PTH levels) and clinical hypocalcemia (symptoms as reported by the patient).Discussion: A prophylactic dietary supplementation with calcium and magnesium, which could easily be implemented in the preoperative setting, could potentially help to avoid or reduce hypocalcemia-associated symptoms and improve quality of life. In the event of a positive outcome, this preoperative procedure can be an inexpensive way to prepare patients scheduled for thyroidectomy and can possibly reduce disease-specific costs by reducing the postoperative complication rate.Clinical Trial Registration: DRKS00017195 in the German clinical trials register (Deutsches Register Klinischer Studien, DRKS) on the 22.05.2019.

The Effect of Intraoperative Nerve Monitor Use on Recurrent Laryngeal Nerve Injury and Hypocalcemia in Benign Thyroid Diseases after Total Thyroidectomy or Loboisthmectomy: Thirteen Years Single Surgeon Experience

Objective: Hypocalcemia is the most common complication after thyroidectomy and recurrent laryngeal nerve (RLN) injury is the most serious complication. In this study, we aimed to investigate the effect of intraoperative nerve monitor (IONM) use on postoperative RLN injury and hypocalcemia in a uniform low-variability group. Material and Methods: Between April 2007 and December 2020, data of patients who underwent surgery due to benign thyroid disease were retrospectively analyzed. Patients under 18 and over 65 years of age, having no euthyroid status during surgery, and having neoplastic pathologies were excluded from the study. A total of 428 patients were included in the study and were divided into two groups. There were 313 patients in Group 1 (non-IONM group) and 115 patients in Group 2 (IONM group). The correlation of the use of IONM with postoperative RLN injury and hypocalcemia was analyzed. Results: There was no permanent vocal cord paralysis. Of the patients, transient vocal cord paresis was seen in 0.61%, transient hypocalcemia in 8.1%, and permanent hypocalcemia in 3.9%. There was no statistically significant difference between the groups regarding RLN injury; however, there was a significant difference in hypocalcemia between the groups (p=0,008). Conclusion: Our study results suggest that IONM use does not significantly reduce the risk of RLN injury, but decreases hypocalcemia, which is one of the most common complications of thyroid surgery, in patients with benign disease undergoing thyroid surgery. Further prospective studies in larger patient series are needed to investigate the IONM use considering pathological examination results, surgical techniques, and demographic data of patients.

Vitamin D repletion in primary hyperparathyroid patients undergoing parathyroidectomy leads to reduced symptomatic hypocalcaemia and reduced length of stay: a retrospective cohort study.

Vitamin D deficiency co-exists with and can confuse the diagnosis of primary hyperparathyroidism (PHPT). Vitamin D replete (VDR) status may prevent significant postparathyroidectomy hypocalcaemia; however, reports from previous studies are conflicting. This study aimed to assess differences in early and/or late postoperative hypocalcaemia and length of stay (LOS) postparathyroidectomy between VDR and vitamin D non-replete (VDNR) PHPT patients. This was a retrospective cohort study of a prospectively maintained single surgeon operative database. All records of patients who underwent parathyroidectomy over a four-year period (July 2014 to December 2018) were extracted. Data were collected on vitamin D and corrected calcium levels pre- and postoperatively as well as postoperative complications and LOS. On presentation, there were 91 (47.9%) VDR and 99 (52.1%) VDNR patients. Following vitamin D therapy there were 148 (77.9%) VDR and 42 (22.1%) VDNR. The multivariate analysis showed that vitamin D status was the only significant factor impacting on the hypocalcaemia symptoms (OR 4.9, 95% CI 1.8-13.7, p = 0.002) and the most significant factor for the calcium supplementation (OR 6.5, 95% CI 2.1-19.4, p = 0.001). Bilateral neck exploration was associated with increased likelihood of transient hypocalcaemia (p = 0.007) but no other post-op complication. Median LOS was significantly shorter for VDR (1 day) versus VDNR (1.5 days) patients (p = 0.001). There is a statistically significant increased likelihood of postoperative hypocalcaemia symptoms, requirement for calcium supplements and increased LOS in VDNR patients. This study suggests optimising preoperative vitamin D status improves patient experience and could reduce healthcare costs.

Does the Risk of Hypocalcemia Increase in Complementary Thyroidectomy Performed in Papillary Thyroid Cancer?

Papillary thyroid cancer (PTC) is the most common type of thyroid cancers. In some patients, due to the histopathological features of PTC, complementary thyroidectomy (CT) may be needed to contralateral thyroid lobe after lobectomy. Hypocalcemia is the most common complication after thyroidectomy and its etiology is multifactorial. It is still controversial whether the CT increases the risk of hypocalcemia or not. In this study, we aimed to evaluate whether CT procedure increases the risk of hypocalcemia compared to total thyroidectomy (TT) in PTC patients. The data of the patients who were operated between 2015 and 2018 and diagnosed with PTC in the pre-operative or post-operative period were evaluated retrospectively, and two patient groups were formed. Group 1 included 19 patients who were diagnosed with PTC in the pathological examination after lobectomy was performed in the first operation, and after that CT was performed to the contralateral lobe. Among the patients who were diagnosed with pre-operative or post-operative PTC in the same period, 53 patients with characteristics similar to the 1st group in terms of age and gender were selected for Group 2. Biochemical parameters related to calcium metabolism in the pre-operative and post-operative periods, parathyroid autotransplantation and unintentional parathyroid gland removal, post-operative hypocalcemia, and treatment rates were compared between the two groups. There were 19 patients (13 F and 6 M) with a mean age of 48.3±12.1 years and 53 patients with a mean age of 46.3±9 (40 F and 13 M) in Groups 1 and 2, respectively, and there was no significant difference between the groups in terms of age and gender. There was no significant difference in terms of pre-operative parathormone (PTH), phosphorus (P), magnesium (Mg), Vitamin D deficiency rate, parathyroid autotransplantation, and presence of parathyroid gland in thyroid specimen. Pre-operative calcium (Ca) value was 9.33±0.46 in Group 1 and lower than Group 2 (9.65±0.41) (p=0.012). There was no significant difference between the groups in terms of post-operative day 0 Ca, P, Mg, and PTH and post-operative day 1 Ca, Mg, and PTH. Post-operative day 1 P level was significantly lower in Group 1 (2.86±0.72) compared to Group 2 (3.6±0.83). Post-operative hypocalcemia rates were 21.1% and 30.2% in Groups 1 and 2, respectively, and the difference was not significant (p=0.558). In both groups, hypocalcemia was transient and permanent hypoparathyroidism was not detected. Parathyroid autotransplantation rates (10.5% vs. 3.8%; p=0.283) and the rate of unintentionally removed parathyroid gland (0 vs. 15.1; p=0.185) were similar in Groups 1 and 2, respectively. Ca and active Vitamin D administration rates in the post-operative period were similar in Group 1 and Group 2 (10.5% vs. 22.6%; respectively), and there was no significant difference between the groups in terms of receiving treatment (p=0.327). CT can be necessary in some patients with post-operative diagnose of PTC. CT can be performed without increased risk of hypocalcemia compared to TT.

Pre and Postoperative Serum Parathyroid Hormone, Calcium and Magnesium Levels in Thyroidectomy Patients in Tertiary Care Hospital of Southern India: A Prospective Observational Study

Introduction: Thyroidectomy has been established as the preferred operation for various thyroid disorders in various forms, ranging from hemithyroidectomy, subtotal to total thyroidectomy. Postoperative hypocalcaemia is one of the most common complications that is observed in patients who undergo total thyroidectomy. To minimise the postoperative complications and to minimise hospital stay and early discharge, it is important to predict patients at risk of developing hypocalcaemia. Measurements of Parathyroid Hormone (PTH) in the immediate postoperative period along with serum calcium are useful and reliable methods. Aim: To determine the risk of post total thyroidectomy by measuring PTH level after total thyroidectomy and compare serum calcium and magnesium levels pre and two hours post total thyroidectomy. Materials and Methods: A prospective observational study was conducted on 34 patients, who underwent total thyroidectomy, from October 2018- May 2020. Preoperative calcium, magnesium and PTH were compared with postoperative calcium, magnesium and PTH. All data were analysed using Statistical Package for the Social Sciences (SPSS) for Windows, Version 22.0. Paired t-test was used to compare and find an association. results: Present study included six males (17.6%) and 28 females (82.4%), there was statistically significant difference between postoperative calcium levels in total thyroidectomy without central neck dissection (mean of 8.36) and postoperative calcium levels in total thyroidectomy with neck dissection (mean of 7.67). There was a significant statistical association between postoperative calcium and postoperative PTH levels (p&lt;0.001). Present study observed significant positive correlation coefficient (r=0.698) and a high level of significance (p&lt;0.001) for postoperative calcium and postoperative PTH. Present study showed no definitive correlation between postoperative serum magnesium and calcium levels. conclusion: For predicting the risk of hypocalcaemia after thyroidectomy it is more reliable to measure the serum PTH level before and after operation and compare the reduction level of percentage of PTH drop for predicting the risk of hypocalcaemia.

Influence of Single Experience with Intraoperative Near-Infrared Autofluorescence on Postoperative Parathyroid Insufficiency after Thyroidectomy - A Preliminary Clinical Study.

Introduction: Total thyroidectomy has become the most common thyroid procedure. This treatment method results in most postoperative hypocalcemia (PH) and hypoparathyroidism (HPT) cases due to the unwitting removal of the parathyroid glands (PTGs). Near-infrared autofluorescence (NIRAF) is a new method that helps identify PTGs. This study aimed to determine whether short-term experience with intraoperative NIRAF may influence postoperative complications after thyroidectomy.Materials and methods: Overall, 65 patients who underwent thyroidectomy by one high-volume surgeon were enrolled in the study between March 2018 and August 2021. In August 2020, the surgeon performed four operations using the NIRAF device. After that experience, the technique of operating and preserving PTGs has been totally changed. Postoperative serum calcium (Ca) and parathormone (PTH) concentrations were measured. Using retrospective study analysis, we assessed the rate of PH and HPT.Results: There was no statistically significant difference in Ca (p = 0.1612) and PTH (p = 0.3590) concentrations between groups operated on before and after the NIRAF experience. The serum concentrations of Ca and PTH of all patients were positively correlated (r = 0.4074; p = 0.0022) as well as the Ca concentration and age of patients (r = 0.3292; p = 0.0116), respectively.Conclusions: These findings suggest that short-term NIRAF experience, and changing attitude to preserving PTGs does not affect thyroidectomy outcomes, even when utilized by a highly experienced high-volume thyroid surgeon. However, continuous use of NIRAF might enhance treatment outcomes, particularly for surgeons with limited experience.

A prospective study of incidence of hypocalcemia following total thyroidectomy

Aims & Objectives of the study: This is a prospective study to evaluate the incidence of hypocalcemia (both transient and permanent) following total thyroidectomy. About 120 patients were included over a period of 3 years from January 2018 to December 2021 admitted in department of general surgery, Trichy SRM Medical College and Research centre. Observation and Conclusion: Postoperative hypocalcemia is the most common and sometimes the most severe and potentially debilitating complication observed after Near total thyroidectomy and Total thyroidectomy. Regarding the sex distribution in this study, there were 23 males (19.2%) and 117 females (81.8%), thus we can infer that thyroid disorders are overwhelmingly more common in the fairer sex. But malignancy of thyroid gland was more common in male gender (60% of cases), probably male gender being in a greater risk for malignancy as per the AGES/AMES Criteria for thyroid malignancies. But the benign disorders of thyroid were more common among females in age group of 20-50 yrs (60%). Malignant disorders of thyroid were more common after 50 yrs of age. The incidence of hypocalcemia (transient) in our study is 21.6% and permanent hypocalcemia requiring lifelong calcium and/or vitamin D3 supplementation is 7.5%.

Clinical and Biological Effects and Quality of Life After Parathyroidectomy in Patients with Hyperparathyroidism Secondary to Chronic Renal Failure

Surgical treatment of hyperparathyroidism secondary to chronic renal failure still finds its place despite advances in dialysis and medical treatment. After a certain period of development, surgical management takes place on forms that are particularly symptomatic and resistant to medical treatment. The aim of our study is to evaluate the clinical and biological effects of parathyroidectomy and to correlate the results with a questionnaire on the quality of life. Through a retrospective study of 32 patients, operated over a period of 10 years in the Department of Surgery "A" of Ibn Sina Hospital in Rabat. We evaluated the clinical and biological effects of parathyroidectomy at the 3-year followup. The gesture achieved consists of parathyroidectomy 7/8e in the majority of cases after research and identification of the parathyroid glands. Postoperative hypocalcaemia was present in 22 cases (68.75%), and was symptomatic in 04 cases. Medium and long-term outcomes were satisfactory for the majority of patients clinically and biologically. The clinical improvement evaluated by a PAS (Parathyroidectomy Assessment of Symptoms) questionnaire before and one year after parathyroidectomy was statistically significant. Biologically, hematocrit improvement, decreased parathyroid hormone and alkaline phosphatase were statistically significant between 3 months and 3 years after parathyroidectomy.

The Relationship Between the Serum Level of Vitamin D and Hypocalcemia After Total Thyroidectomy

Vitamin D plays a crucial role in calcium metabolism through the parathormone-dependent process. The deficiency of this important nutrient may be associated with hypocalcemia after thyroidectomy. To evaluate the role of vitamin D in predicting hypocalcemia following total thyroidectomy. In this study, sixty-two patients who underwent total thyroidectomy for benign or malignant thyroid disease were included in this prospective study. Preoperative vitamin D serum levels and parathormone (PTH) levels were determined. The association between preoperative vitamin D status and the development of hypocalcemia was investigated. In this study, 62 patients were evaluated. The mean age of the subjects was 47 years. Of the 62 patients studied, of which 9 were male patients (14.5%), and 53 were female (85.5%), the results of our study showed. In both groups with and without vitamin D deficiency, calcium levels decreased significantly (P=0.01). In our study, it was found that there was no significant relationship between postoperative hypocalcemia and vitamin D deficiency. (P=0.441). After reviewing the data and according to Spearman correlation statistical test, no significant relationship was observed between serum parathyroid hormone (PTH) and calcium after thyroidectomy (P=0.340). Vitamin D deficiency is a risk factor of hypocalcemia after total thyroidectomy for benign goiter. Although post thyroidectomy hypocalcemia is multifactorial, vitamin D deficiency, particularly severe form, is significantly associated with the development of biochemical and clinical hypocalcemia. Vitamin D supplementation can prevent this unwanted complication in such patients.

Thyroidectomy with and without laryngectomy: Differences in post-operative hypocalcemia and management

BackgroundTotal laryngectomy (TL) with thyroidectomy can pose significant risks to parathyroid function, and variance in rates of post-operative hypocalcemia (POH) based on extent of thyroidectomy have not been previously reported. Our objective is to identify the rates of hypocalcemia and hypoparathyroidism in TL+/−thyroidectomy and compare this to matched thyroidectomy alone cohorts. MethodsMulti-institutional retrospective chart review of patients treated surgically for laryngeal cancer with TL or benign/malignant thyroid disease with thyroidectomy at regional tertiary care centers in New Orleans and Baton Rouge, Louisiana from 2016 to 2019. Cases were evaluated for post-operative and post-discharge calcium and parathyroid hormone levels, post-operative and long-term calcium supplementation, and intraoperative parathyroid identification and management. Results101 TL and 319 thyroidectomy patients' charts were reviewed. Regression analysis revealed increased odds of hypocalcemia and hypoparathyroidism in TL + TT versus TT alone (OR 10.7, OR 16.5, p < 0.001, respectively). TL + HT versus HT alone had increased odds of hypoparathyroidism (OR 1.6, p < 0.001). TL with any thyroidectomy compared to TL alone demonstrated both increased odds of hypocalcemia and hypoparathyroidism (OR 4.4 p = 0.009, and OR 4.5 p = 0.05). Odds of requiring long-term calcium supplementation were significantly increased with the addition of thyroidectomy across all groups. TL + TT was 8 times as likely (p = 0.002) and TL + HT was 5.3 times as likely (p = 0.001) to require long-term calcium supplementation compared to TL alone. ConclusionsThyroidectomy combined with TL demonstrates marked increased risk of parathyroid dysfunction and resultant POH. Despite improved visualization of soft tissue anatomy with TL, risk of parathyroid injury in these settings requires special attention to extent of parathyroid dissection and potential devascularization to reduce long-term sequelae of hyperparathyroidism. Therefore, post-operative calcium monitoring after TL is necessary and should resemble the long-standing stringent protocols that already exist for monitoring in thyroidectomy populations.

Incidence, survival time, and surgical treatment of parathyroid carcinomas in dogs: 100 cases (2010-2019).

To evaluate outcomes of dogs with parathyroid carcinoma (PTC) treated by surgical excision and to describe the incidence of postoperative hypocalcemia, degree of hypocalcemia, duration of hospitalization, duration of calcium supplementation, and survival time. 100 client-owned dogs with PTC admitted to academic, referral veterinary institutions. In a retrospective multi-institutional study, medical records of dogs undergoing surgical excision of PTC between 2010 to 2019 were reviewed. Signalment, relevant medical history, clinical signs, clinicopathologic testing, imaging, surgical findings, intraoperative complications, histologic examination, and survival time were recorded. 100 dogs with PTC were included, and 96 dogs had clinical or incidental hypercalcemia. Common clinical signs included polyuria (44%), polydipsia (43%), hind limb paresis (22%), lethargy (21%), and hyporexia (20%). Cervical ultrasonography detected a parathyroid nodule in 91 of 91 dogs, with a single nodule in 70.3% (64/91), 2 nodules in 25.3% (23/91), and ≥ 3 nodules in 4 (4/91)% of dogs. Hypercalcemia resolved in 89 of 96 dogs within 7 days after surgery. Thirty-four percent of dogs developed hypocalcemia, on the basis of individual analyzer ranges, within 1 week after surgery. One dog had metastatic PTC to the prescapular lymph node, and 3 dogs were euthanized for refractory postoperative hypocalcemia. Estimated 1-, 2-, and 3-year survival rates were 84%, 65%, and 51% respectively, with a median survival time of 2 years. Excision of PTC results in resolution of hypercalcemia and excellent long-term tumor control. Surgical excision of PTC is recommended because of resolution of hypercalcemia and a good long-term prognosis. Future prospective studies and long-term follow-up are needed to further assess primary tumor recurrence, metastasis, and incidence of postoperative hypocalcemia.

Post-Thyroidectomy Hypocalcemia: A Single-Center Experience

IntroductionThyroidectomy is a frequent operation performed worldwide. The most common complication following thyroid surgery is hypocalcemia, caused by transient or persistent hypoparathyroidism. This study aimed to investigate the prevalence of hypocalcemia after thyroidectomy and to identify potential risk factors.MethodsAll thyroidectomies performed at a single tertiary center between 2012 and 2017 were retrospectively analyzed. Post-thyroidectomy hypocalcemia was evaluated in relation to risk factors such as age, sex, procedure type, and type of thyroid disease. Data were extracted from patient medical records. Patients with pre-operative hypocalcemia were excluded.ResultsWe enrolled 182 patients who underwent thyroidectomy. Female patients comprised 83% (n = 151) of the total patients. Of all patients, 116 (63.7%) had developed post-operative temporary hypocalcemia and three (1.6%) had persistent hypocalcemia. Remarkably, no cases of mortality were reported. There was no significant relationship between the occurrence of hypocalcemia and age, type of thyroid disease, and sex. Conversely, there was a significant relationship between the development of hypocalcemia and the type of procedure (P < 0.001).ConclusionThyroidectomy is a safe surgery with few complications when performed by a skilled surgeon. These complications result in longer hospital stays and higher costs. The most common post-thyroidectomy complication was hypocalcemia. Furthermore, patients who underwent total thyroidectomy were at the greatest risk of developing post-thyroidectomy hypocalcemia.

Intraoperative Parathyroid Hormone Assessment in Patients with Primary Hyperparathyroidism – One–Year Experience

Purpose: We evaluated our one– year experience in the intraoperative measurement of parathyroid hormone (IOPTH) in parathyroid adenoma surgery. We also compared surgical outcome after minimally invasive parathyroidectomy (MIP) and conventional neck exploration (CNE).&#x0D; Methods: Between April 2011 and April 2012, eight consecutive patients with primary hyperparathyroidism (PHP) underwent parathyroidectomy with IOPTH in our institution. Parathyroidectomy was defined as successful when a &gt;50% decrease of IOPTH was observed 10 minutes after resection of the abnormal gland. The second criterion for success was a six month period of postoperative normocalcaemia.&#x0D; Results: We performed four MIPs, two unilateral neck explorations, and two bilateral neck explorations, resulting in a total of seven solitary and one double adenomas. IOPTH level decrease expectations were met in all cases. The average length of surgery for MIP was 31 minutes, and 69 minutes for CNE. All patients were eucalcaemic with normal PTH levels during the 6 month follow–up period. Three patients had postoperative hypocalcaemia after CNE and there were no recurrences 6 months postoperatively.&#x0D; Conclusion: The review of our series of eight consecutive patients with PHP showed a 100% cure rate after employing IOPTH measurement in both surgical approaches. The advantages of MIP are: shorter operating time, better cosmetic results, and a lower incidence of hypocalcaemia.

Short-Term Hypocalcemia Prophylaxis With Calcitriol Before Thyroidectomy.

Total thyroidectomy is the most common surgical treatment of thyroid diseases, and postoperative hypocalcemia is its most common complication. Hypocalcemia prolongs the patient's hospital stay and impairs his or her quality of life. Although a low vitamin D level is a recognized risk factor, the utility of preoperative vitamin D administration to prevent postoperative hypocalcemia is unclear. In this trial, therefore, we studied the effect of giving vitamin D before total thyroidectomy. In a multicenter, randomized, minimally interventional trial (registration number: DRKS 00005615), patients about to undergo total thyroidectomy were randomized either to an intervention group that received 0.5 μg of calcitriol per os twice daily for three days up to the day immediately before surgery, or to a control group that did not (no placebo was given). The primary endpoint was the absence of hypocalcemia (serum calcium <2.1 mmol/L) in the postoperative course. Of the 287 patients recruited in six hospitals over the period 23 July 2014 to 20 March 2017, 246 were included in the final analysis. The intervention and control groups did not differ significantly with respect to the rate of postoperative hypocalcemia (29.2% and 33.6%, respectively; p = 0.546, power 8.8%). The duration of postoperative hypocalcemia was, however, shorter in the intervention group (3.5 vs. 7 days; p = 0.016, power 68%). The rates of hypocalcemia in the individual trial locations varied widely, ranging from 13.9% to 71.4%. Short-term administration of calcitriol did not affect the rate of occurrence of hypocalcemia after thyroidectomy, but did shorten its duration. The rate of postoperative hypocalcemia varied widely across hospitals, probably because of differences in surgical technique.

Primary hyperparathyroidism-related giant parathyroid adenoma (Review).

Primary hyperparathyroidism (PHPT), an endocrine condition caused by a parathyroid adenoma (PTA) in 80-85% of the cases, has shifted in the modern era to a mildly symptomatic phenotype due to the prompt recognition of hypercalcemia and to a minimally invasive surgical approach which has a curative potential. Clinical complications of PHTH are either related to high calcium or parathyroid hormone [also parathormone (PTH)] or both, while the originating tumor typically is small, without local mass effects. A distinct entity is represented by giant PTA (GPTA) which is considered at a weight of more than 3 (3.5) grams. The present article is a review of the literature involving practical points of non-syndromic PHPT-related GPTA. Most authors agree that pre-operatory calcium and PTH are higher in GPTA vs. non-GPTA. However, the clinical presentation of PHPT may be less severe, probably due to local mass effects that bring the patient to an early medical evaluation. Age distribution, sex ratio, rate of successful pre-operatory location do not differ from non-giant PTA. Hypovitaminosis D is more frequent in PTA of higher dimensions. Post-operative hypocalcemia, but not recurrent/persistent PHPT, is expected, even hungry bone disease. A higher rate of atypia is described although the tumor is mostly benign. Unusual presentations such as cystic transformation, initial diagnosis during pregnancy or auto-infarction have been reported. The ectopic localization of PTA presented in almost 15% of all cases may also be found in GPTA. What are the exact cutoffs for defining GPTA is still an open issue.