DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20163787

Identification of patients at high risk for hypocalcemia after total thyroidectomy with serial calcium estimation and intact parathyroid hormone levels-a comparative study

Pauly T. J., Santhosh P. V., Santhosh T. V., Vinodh M.

Abstract


Background: In recent years, multiple retrospective and prospective studies have emerged, which support the use of postoperative serum intact parathyroid hormone (iPTH) levels can also predict hypocalcaemia in postoperative thyroidectomy patients. Therefore, the present study was designed to determine the incidence of hypocalcaemia after total thyroidectomy.

Methods: 146 patients who underwent total thyroidectomy were recruited. The incidence of hypocalcaemia was analyzed with serial calcium estimation results with 6 hours, 24 hours, 48 hours and 2 weeks post-operative calcium level estimations. The incidence of hypocalcaemia with regards to the number of parathyroid glands was determined and the results between the three groups were compared.

Results: The incidence of transient hypocalcaemia at 24hr postoperative period and intact parathyroid hormone (iPTH) level showed a significant difference (p<0.001). 49% of the patients were with calcium levels <8 mg/dl in first 24hrs of serial calcium estimation in comparison with the 51% parathormone level with <15pg/dl was also showed a significant difference (p<0.001). Calcium levels lessthan 8 mg/dl. The serial calcium level after 2wks with features of hypocalcemia (<8mg/dl) were 18% and was more predictable and coast effective than intact parathyroid hormone (i PTH) estimation which require Rs.1000-1200 in comparison with the serial calcium estimation of around Rs. 400.

Conclusions: The serial calcium level estimations are more predictable and coast effective than intact parathyroid hormone (i PTH) estimation in predicting long term post-operative hypocalcaemia after total/near total thyroidectomy.


Keywords


Hypocalcaemia, i PTH, Thyroidectomy

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References


Thompson NW, Olsen WR, Hoffman GL. The continuing development of the technique of thyroidectomy. Surgery. 1973;73:913-27.

Shaha AR, Jaffe BM. Parathyroid preservation during thyroid surgery. Am J Otolaryngol. 1998;19:113-7.

Cheah WK, Arici C, Ituarte PH, Siperstein AE, Duh QY, Clark OH. Complications of neck dissection for thyroid cancer. World J Surg. 2002;26:1013-6.

Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery. 2003;133:180-5.

McHenry CR, Speroff T, Wentworth D, Murphy T. Risk factors for postthyroidectomy hypocalcemia. Surgery. 1994;116:641-7.

Demeester-Mirkine N, Hooghe L, Van Geertruyden J, De Maertelaer V. Hypocalcemia after thyroidectomy. Arch Surg. 1992;127:854-8.

Wingert DJ, Friesen SR, Iliopoulos JI, Pierce GE, Thomas JH, Hermreck AS. Post-thyroidectomy hypocalcemia. Incidence and risk factors. Am J Surg. 1986;152:606-10.

Shaha AR, Burnett C, Jaffe BM. Parathyroid autotransplantation during thyroid surgery. J Surg Oncol. 1991;46:21-4.

Olson JA, Jr, DeBenedetti MK, Baumann DS, Wells SA. Jr Parathyroid autotransplantation during thyroidectomy. Results of long-term follow-up. Ann Surg. 1996;223:472-8.

Lee NJ, Blakey JD, Bhuta S, Calcaterra TC. Unintentional parathyroidectomy during thyroidectomy. Laryngoscope. 1999;109:1238-40.

Attie JN, Khafif RA. Preservation of parathyroid glands during total thyroidectomy. Improved technic utilizing microsurgery. Am J Surg. 1975;130:399-404.

Kark AE, Kissin MW, Auerbach R, Meikle M. Voice changes after thyroidectomy: role of the external laryngeal nerve. Br Med J. (Clin Res Ed) 1984;289:1412-5

Crumley RL, Smith JD. Postoperative chylous fistula prevention and management. Laryngoscope. 1976;86:804-13,

Shaha AR, Jaffe BM. Practical management of post-thyroidectomy hematoma. J Surg Oncol. 1994;57:235-8.

Farrar WB, Cooperman M, James AG. Surgical management of papillary and follicular carcinoma of the thyroid. Ann Surg. 1980;192:701-4.

Attie JN, Moskowitz GW, Margouleff D, Levy LM. Feasibility of total thyroidectomy in the treatment of thyroid carcinoma: postoperative radioactive iodine evaluation of 140 cases. Am J Surg. 1979;138:555–60.

Lal G, Ituarte P, Kebebew E, Siperstein A, Duh QY, Clark OH. Should total thyroidectomy become the preferred procedure for surgical management of Graves' disease? Thyroid. 2005;15:569-74.

Pesce CE, Shiue Z, Tsai HL, Umbricht CB, Tufano RP, Dackiw AP, et al. Postoperative hypocalcemia after thyroidectomy for Graves' disease. Thyroid. 2010;20:1279-83.

Kihara M, Yokomise H, Miyauchi A, Matsusaka K. Recovery of parathyroid function after total thyroidectomy. Surg Today. 2000; 30:333-8.

Percival RC, Hargreaves AW, Kanis JA. The mechanism of hypocalcaemia following thyroidectomy. Acta Endocrinol (Copenh). 1985;109:220-6.