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.


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.


Hypocalcaemia, i PTH, Thyroidectomy

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