Transient Hypocalcemia after Thyroidectomy

1993 ◽  
Vol 102 (7) ◽  
pp. 496-501 ◽  
Author(s):  
Christophe Bourrel ◽  
Bernard Uzzan ◽  
Pierre Tison ◽  
Gilles Despreaux ◽  
Bruno Frachet ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Thyroid Carcinoma ◽  
Total Thyroidectomy ◽  
Blood Supply ◽  
Serum Calcium ◽  
Thyroid Surgery ◽  
Subtotal Thyroidectomy ◽  
Total Calcium ◽  
Blood Withdrawal ◽  
Persistent Symptoms

The causes of transient hypocalcemia after thyroid surgery are not fully understood. In 95 consecutive patients undergoing total thyroidectomy (n = 30), subtotal thyroidectomy (n = 14), or hemithyroidectomy (n = 51), we serially measured total calcium, parathyroid hormone (PTH), and proteins before surgery and 6, 24, 48, 72, and 96 hours after surgery, and we calculated the corresponding ionized calcium levels. In the whole population, there was a statistically significant decrease of PTH, total calcium, and proteins at nearly every time of blood withdrawal, when compared with the preoperative levels. The PTH decreased earlier and total calcium levels were significantly lower after total thyroidectomy than after hemithyroidectomy (at 48, 72, and 96 hours). Ten patients had on 2 occasions serum calcium levels below or equal to 2 mmol/L and were defined as having severe hypocalcemia. Severe hypocalcemia was found in 8 patients after total thyroidectomy, compared with 2 after hemithyroidectomy (p < .05), and was present in 3 of the 5 patients with thyroid carcinoma, compared with 7 of the 90 patients with nonmalignant thyroid diseases (p < .01). Despite careful preservation of the parathyroid glands and their blood supply, thyroidectomy was often followed by transient hypocalcemia, the determinants of which are hypoparathyroidism and hemodilution. No patients had persistent symptoms of hypocalcemia from 2 to 3 months after surgery.

scholarly journals Difficult Decision on Tyroid Surgery of Expert Witness: Complication or Malpractice

2017 ◽  
Vol 23 (2) ◽  
pp. 89-92
Author(s):  
Ali Rıza Tümer ◽  
Mahmut Şerif Yıldırım ◽  
Savaş Koçak
Keyword(s):  
Thyroid Carcinoma ◽  
Total Thyroidectomy ◽  
Cancer Patients ◽  
Thyroid Surgery ◽  
Expert Witness ◽  
Nodular Goiter ◽  
Laryngeal Nerve ◽  
Subtotal Thyroidectomy ◽  
Difficult Decision ◽  
Common Problems

Objective: Recurrent laryngeal nerve (RLN) paralysis and hypocalcemia following thyroid surgery have been designated as complication or malpractice. In this study, it was aimed to evaluate surgeons’ opinions towards RLN injury and hypocalcemia after bilateral subtotal thyroidectomy (BST) and total thyroidectomy (TT) in nodular goiter and thyroid carcinoma. Materials and Methods: We prepared a questionnaire to determine approaches of surgeons in such cases. We grouped the respondents according their thyroid surgery experiments and asked them to determine whether it is malpractice or complication in cases with unilateral or bilateral RLN paralysis and hypocalcemia after “bilateral subtotal thyroidectomy” and in cases with unilateral or bilateral RLN paralysis after “total thyroidectomy”. Results: In all groups describing bilateral RLN injury was more common. Problems which are defined as “complication” in cancer patients, were more likely defined as “malpractice” in benign cases. However, these differences were generally not statistically significant. Conclusion: There is no consensus about malpractice and complication discrimination among physicians. Every physician should evaluate every specific case in its own nature and conditions when asked to determine whether the case should be determined as complication or malpractice.

Major post-operative complications of thyroid surgery: Preventable or not?

2009 ◽  
Vol 34 (3) ◽  
pp. 99-103 ◽  
Author(s):  
M.A. Majid ◽  
Md. Ibrahim Siddique
Keyword(s):  
Total Thyroidectomy ◽  
Vocal Cord ◽  
Thyroid Surgery ◽  
Multinodular Goiter ◽  
Vocal Cord Palsy ◽  
Subtotal Thyroidectomy ◽  
Permanent Hypoparathyroidism ◽  
Respiratory Obstruction ◽  
Operative Complications ◽  
Toxic Multinodular Goiter

Factors responsible for major complications following thyroid surgery in 598 patients were studied. Patients with non toxic multinodular goiter involving both lobes of thyroid constituted the maximum bulk subjected to thyroidectomy. The most frequent procedure was bilateral subtotal thyroidectomy. Reactionary hemorrhage occurred in 6 patients, all following bilateral procedures and among them 5 patients developed tension hematoma with respiratory obstruction despite the presence of a drain. Temporary vocal cord palsy was observed in 7 patients whereas one patient subjected to total thyroidectomy with neck dissection for papillary carcinoma of thyroid developed permanent right vocal cord palsy. Temporary parathyroid insufficiency was seen in 51 patients and one patient developed permanent hypoparathyroidism. Incidence of parathyroid insufficiency was higher in bilateral procedures as compared to unilateral ones. There was no operation related death in this series, but complications like hemorrhage, vocal cord palsy and parathyroid insufficiency following thyroid surgery are still a deep concern. Keywords: Complication; Post-operative; Thyroid surgeryOnline: 29-1-2009DOI: 10.3329/bmrcb.v34i3.1973     Bangladesh Med Res Counc Bull 2008; 34: 99-103. 

Impact of pre-operative serum 25-hydroxyvitamin D on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre: retrospective study of 246 patients

2017 ◽  
Vol 131 (10) ◽  
pp. 925-929 ◽  
Author(s):  
M Erlem ◽  
N Klopp-Dutote ◽  
A Biet-Hornstein ◽  
V Strunski ◽  
C Page
Keyword(s):  
Parathyroid Hormone ◽  
Retrospective Study ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Univariate Analysis ◽  
Multinodular Goitre ◽  
Serum Parathyroid Hormone ◽  
Single Centre ◽  
Hydroxyvitamin D ◽  
25 Hydroxyvitamin D

AbstractObjective:To determine whether pre-operative serum 25-hydroxyvitamin D has an impact on post-operative parathyroid hormone and serum calcium levels in patients undergoing total thyroidectomy for benign goitre.Methods:This single-centre, retrospective study comprised 246 unselected surgical patients who had undergone total thyroidectomy for bilateral, benign, multinodular goitre. The correlation between pre-operative serum 25-hydroxyvitamin D and post-operative serum parathyroid hormone and serum calcium was studied to determine whether low pre-operative serum 25-hydroxyvitamin D was predictive of post-operative hypocalcaemia.Results:Seventy-nine patients (32 per cent) had post-operative hypocalcaemia. Eighteen patients (7.32 per cent) experienced unintentional parathyroidectomy (1 parathyroid gland in 15 patients, 2 parathyroid glands in 3 patients). In univariate analysis, pre-operative serum 25-hydroxyvitamin D was not correlated with post-operative serum calcium (p = 0.69) or post-operative serum parathyroid hormone (p = 0.5804). Furthermore, in multivariate analysis, which took into account unintentional parathyroidectomy, no correlation was found (p = 0.33). Bilateral unintentional parathyroidectomy was statistically associated with post-operative hypocalcaemia (p = 0.032).Conclusion:Pre-operative serum 25-hydroxyvitamin D did not appear to have any impact on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre.

scholarly journals Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy

2012 ◽  
Vol 56 (3) ◽  
pp. 168-172 ◽  
Author(s):  
Felipe Augusto Brasileiro Vanderlei ◽  
Jose Gilberto Henriques Vieira ◽  
Flavio Carneiro Hojaij ◽  
Onivaldo Cervantes ◽  
Ilda Sizue Kunii ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Vitamin D Supplementation ◽  
Cutoff Value ◽  
Increased Risk ◽  
Symptomatic Hypocalcemia ◽  
Early Predictor ◽  
Selection Of

OBJECTIVE: The purpose of this study was to evaluate if the measurement of peri-operative parathyroid hormone (PTH) is able to identify patients with increased risk of developing symptoms of hypocalcemia. SUBJECTS AND METHODS: Forty patients who underwent total thyroidectomy were studied prospectively. Ionized serum calcium and PTH were measured after induction of anesthesia, one hour (PTH1) and one day after surgery (PTH24). Patients were evaluated for symptoms of hypocalcemia and treated with calcium and vitamin D supplementation as necessary. RESULTS: Symptomatic hypocalcemia developed in 16 patients. Symptomatic patients had significant lower PTH1 and greater drops in PTH levels. The selection of 12.1 ng/L as PTH1 level cutoff level divided patients with and without symptoms with 93.7% sensitivity and 91.6% specificity. The selection of 73.5% as the cutoff value for PTH decrease resulted in 91.6% sensitivity and 87.5% specificity. CONCLUSION: PTH1 levels and the drop in PTH levels are reliable predictors of developing symptomatic hypocalcemia after total thyroidectomy.

scholarly journals Parathyroid hormone and serum calcium levels measurements as predictors of postoperative hypocalcemia in total thyroidectomy

Gland Surgery ◽  
2017 ◽  
Vol 6 (5) ◽  
pp. 428-432 ◽  
Author(s):  
Mohammed Algarni ◽  
Rajab Alzahrani ◽  
Gianlorenzo Dionigi ◽  
Al-Hakami Hadi ◽  
Haia AlSubayea
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Postoperative Hypocalcemia

scholarly journals Comparing the Outcomes of Thyroid Surgical Procedures for Benign Diseases with Expertise of the Surgeon in a Tertiary Care Hospital in Rawalpindi, Pakistan

2021 ◽  
Vol 10 (2) ◽  
pp. 68-75
Author(s):  
Nadir Mehmood Mehmood ◽  
Liaquat Ali Bhatti ◽  
M. Idrees Anwar ◽  
M. Aslam Chaudhry ◽  
Malik Irfan Ahmed ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Surgical Procedures ◽  
Thyroid Surgery ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Subtotal Thyroidectomy ◽  
Care Hospital ◽  
Benign Diseases ◽  
Cross Sectional ◽  
Permanent Hypocalcemia

Background: There is a lack of standardized guidelines regarding selection of appropriate thyroid surgery for patients with benign diseases. As a result, an inexperienced surgeon may select a more aggressive surgical option, which may increase the complication rate. The objective of this study was to compare the outcomes of thyroid surgical procedures for benign diseases with the expertise of the surgeon.Material and Methods: A retrospective cross-sectional study from 1999 to 2018. The study setting is of a public sector tertiary care teaching hospital. Patients undergoing thyroid surgery (lobectomy with isthmusectomy, subtotal thyroidectomy (STT), near total thyroidectomy (NTT), or total thyroidectomy (TT)) were included. Expertise level 1, 2 and 3 (L1, L2, L3) of the surgeon was based on years of experience or number of thyroid surgeries to their credit. Postoperative complications (hypocalcemia, recurrent laryngeal nerve (RLN) damage, airway obstruction, hemorrhage and mortality) were measured against type of thyroid surgery and expertise of the surgeon.Results: A total of 833 thyroid surgeries were performed on 695 (83.43%) females and 138 (16.57%) males. About 502 (60.26%) STT, 228 (27.37%) TT, 61 (7.32%) NTT, 42 (5.04%) lobectomies with isthmusectomies were performed, with LI, 2, and 3 surgeons performing 21.25%, 45.74% and 33% of these procedures, respectively. Surgeons with L1, 2 and 3 levels of expertise caused 49.47%, 33.45% and 17.08% of adverse events, respectively. Permanent hypocalcemia, RLN damage and mortality were significantly more common in surgeries performed by L1 compared with L2 and L3 surgeons (P<.05). Transient and permanent hypocalcemia, transient and permanent RLN damage and mortality were significantly more common for total thyroidectomy compared to subtotal thyroidectomy (P<.01).Conclusions: Minimizing the occurrence of complications like permanent hypocalcemia, RLN damage and mortality, expertise of the surgeon and anticipated difficulty of the procedure needs to be taken into account while selecting a thyroid procedure.

DO NEAR-INFRARED INTRA-OPERATIVE FINDINGS OBTAINED USING INDOCYANINE GREEN CORRELATE WITH POST-THYROIDECTOMY PARATHYROID FUNCTION? THE ICGPREDICT STUDY

2020 ◽  
Vol 26 (9) ◽  
pp. 967-973
Author(s):  
Theodosios S. Papavramidis ◽  
Panagiotis Anagnostis ◽  
Angeliki Chorti ◽  
Ioannis Pliakos ◽  
Stavros Panidis ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Indocyanine Green ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Scoring System ◽  
Near Infrared ◽  
Eligibility Criteria ◽  
Hydroxyvitamin D ◽  
Postoperative Hypoparathyroidism ◽  
Operative Findings

Objective: Postoperative hypoparathyroidism (hypoPT) still remains a significant complication after thyroidectomy. Intra-operative imaging modalities, such as near-infrared fluorescence using indocyanine green (ICG), may assist in identifying and preserving the parathyroid glands (PGs). The purpose of this study was to test the association between the intra-operative ICG staining scoring system and 24-hour postoperative parathyroid hormone (PTH) levels, as well as its capability for intra-operative PG identification. Methods: This was a prospective study, recruiting patients scheduled for total thyroidectomy by the same surgical team, from December 2018 to April 2019. Intra-operative angiography was performed after infusion of ICG solution (5 mg). Two minutes later, images were acquired using the near-infrared system. Results: Sixty patients fulfilled the eligibility criteria. The percentage of temporary postoperative hypoPT (defined as PTH <14 pg/mL) was 11.66%. No association between intra-operative ICG staining score (expressed as the number of PGs scoring <2 per patient) and 24-hour postoperative PTH ( r = 0.011; P = .933) or serum calcium concentrations ( r = 0.127; P = .335) was observed. There was also no correlation between the location of PGs scoring ≤2 and postoperative PTH ( P = .257) or serum calcium levels ( P = .950). Moreover, with regard to secondary endpoint, ICG correctly identified PGs in 98.3% of cases. ICG score was not affected by age, gender, duration of operation, or thyroid gland pathology. No allergic reactions attributed to ICG administration were observed. Conclusion: The intra-operative ICG staining scoring system did not predict 24-hour postoperative PTH and serum calcium levels. However, this modality may assist in intra-operative PG identification during a total thyroidectomy. Abbreviations: 25(OH)D = 25-hydroxyvitamin D; hypoPT = hypoparathyroidism; ICG = indocyanine green; NIR = near-infrared; NIRF = near-infrared autofluorescence; PG = parathyroid gland; PTH = parathyroid hormone

EFFECT OF POST-SURGICAL RAI THERAPY ON PARATHYROID FUNCTION IN PATIENTS WITH DIFFERENTIATED THYROID CANCER

2020 ◽  
Vol 26 (4) ◽  
pp. 416-422 ◽  
Author(s):  
Aimi Zhang ◽  
Panli Li ◽  
Qiufang Liu ◽  
Shiyao Peng ◽  
Gang Huang ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Thyroid Carcinoma ◽  
Serum Calcium ◽  
Differentiated Thyroid Carcinoma ◽  
Whole Body ◽  
Whole Body Scan ◽  
Body Scan ◽  
Thyroid Scan ◽  
Parathyroid Function ◽  
Iodine 131

Objective: Radiotherapy with radioactive iodine (RAI) has become a common treatment for postsurgical differentiated thyroid carcinoma (DTC). The objective of this study was to determine the effect of RAI therapy following surgery on the function of the parathyroid glands in DTC patients. Methods: A total of 81 DTC patients who received RAI therapy after surgery were enrolled in the study. The size of the residual thyroid was detected by technetium-99m (99mTc)-pertechnetate thyroid scan (99mTc thyroid scan) before RAI therapy. The iodine uptake ability of residual thyroid was evaluated by iodine-131 (131I) whole-body scan (WBS). All patients were treated with an activity of 3.7 GBq (100 mCi) 131I. Parathyroid hormone (PTH), serum calcium, phosphorus, and magnesium were evaluated at 1 day before treatment, and at 1 month and 3 months after treatment. Results: The results show that there was no statistically significant difference in blood PTH level observed ( P>.05) between 3 time points (pre-treatment, 1 month post-treatment and 3 months post-treatment). The serum calcium and phosphorus did not change significantly ( P>.05), but serum magnesium level was elevated after treatment ( P<.05). There were no significant differences between PTH changes and sex, age, scores of 99mTc thyroid scan, scores of 131I WBS, Tumor (T) stage, and Node (N) stage. Conclusion: RAI therapy following surgery did not significantly affect parathyroid function in DTC patients. Abbreviations: ATA = American Thyroid Association; DTC = differentiated thyroid carcinoma; FT3 = free triiodothyronine; FT4 = free thyroxine; 131I = iodine-131; PTH = parathyroid hormone; RAI = radioiodine; 99mTc = Technetium-99m; TG = thyroglobulin; TNM = Tumor Node Metastasis; TSH = thyroid-stimulating hormone; WBS = whole-body scan

scholarly journals The Timing of Calcium Measurements in Helping to Predict Temporary and Permanent Hypocalcaemia in Patients Having Completion and Total Thyroidectomies

2009 ◽  
Vol 91 (2) ◽  
pp. 140-146 ◽  
Author(s):  
AG Pfleiderer ◽  
N Ahmad ◽  
MR Draper ◽  
K Vrotsou ◽  
WK Smith
Keyword(s):  
Adverse Effect ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Thyroid Surgery ◽  
Calcium Level ◽  
Clinical Symptoms ◽  
Post Surgery ◽  
Patient Will ◽  
Serial Serum ◽  
Vitamin D Supplements

INTRODUCTION Postoperative hypocalaemia commonly occurs after extensive thyroid surgery and may require calcium and/or vitamin D supplements to alleviate or prevent the symptoms. In this study, we determined the risk factors for developing hypocalcaemia and whether early serum calcium levels can predict the development of or differentiate between temporary or permanent hypocalcaemia. PATIENTS AND METHODS A total of 162 patients who either had a completion or total thyroidectomy formed the basis of this prospective study. Serial serum calcium measurements were recorded as well as details of the operation, pathology, indications for surgery, number of parathyroids identified at operation and any complications. RESULTS Eighty-four (52%) patients did not develop hypocalcaemia but 69 (43%) were found to have temporary hypocalcaemia and 9 (5%) had permanent hypocalcaemia. Hypocalcaemia was more common after total than completion thyroidectomies and the identification of parathyroids at operation appears to have a significant adverse effect on outcome. The calcium levels measured on day 1 postoperatively and the slope (serum calcium levels of day 1 postoperative minus day of operation) were statistically significant in predicting the development of hypocalcaemia and possibly to differentiate between temporary or permanent hypocalcaemia. DISCUSSION Although almost half the patients having extensive thyroid surgery developed hypocalcaemia (as defined by any postoperative corrected serum calcium level of < 2.12 mmol/l) only 24% had a serum calcium of < 2.12 mmol/l associated with clinical symptoms of hypocalcaemia or a calcium level of < 2.0 mmol/l. Only 5% had persistent hypocalcaemia defined as requiring exogenous supplements at 6 months' postoperatively. Patients having a completion thyroidectomy appear to be less likely to develop hypocalcaemia perhaps as a result of any iatrogenic effects on the parathyroids at the first operation being reversed before the second operation. Identification and, therefore, exposure of parathyroids at operation may have an adverse effect on the blood supply to the glands affecting their function. CONCLUSIONS Serum calcium levels measured 6 hours' post-surgery and on day 1 postoperatively can be useful in predicting if the patient will develop hypocalcaemia and the slope may indicate whether the hypocalcaemia will be temporary or permanent. Patients with toxic goitres and those having a one-stage total thyroidectomy are most at risk of developing hypocalcaemia.

The Utility of Serum PTH Assessment 24 Hours after Total Thyroidectomy

2005 ◽  
Vol 132 (4) ◽  
pp. 584-586 ◽  
Author(s):  
Paolo Del Rio ◽  
Maria Francesca Arcuri ◽  
Giovanni Ferreri ◽  
Lucia Sommaruga ◽  
Mario Sianesi
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Normal Values ◽  
Laboratory Findings ◽  
Male Ratio ◽  
Normal Limits ◽  
Calcium Phosphorus ◽  
Serum Pth ◽  
Preoperative Examination

BACKGROUND: Hypocalcemia is the most frequent complication following total thyroidectomy. This prospective study examines the predictive value of parathyroid hormone (PTH) levels measured 24 hours after surgery. MATERIAL AND METHODS: A total of 1006 consecutive patients (mean age, 54.8 years; female/male ratio, 4/1) underwent total thyroidectomy for benign or malignant thyroid from January 1995 to November 2003. Serum calcium, phosphorus, and PTH were measured preoperatively and at 24 hours after surgery. All patients underwent preoperative examination to assess cord motility. RESULTS: A total of 253 (25.1%) patients presented with hypocalcemia demonstrated by clinical and laboratory findings. In 101 cases the hypocalcemic syndrome manifested after 24 to 36 hours whereas in 5 of 101 cases, symptom onset was between 48 and 72 hours. Serum calcium levels lower than 7.5 mg/dL were recorded in all the 101 cases. In 239 of 253 cases serum calcium returned to normal values within 7 days following surgery. PTH at 24 hours was below normal levels in 49 of the 101 patients but was within normal limits in 52 cases. The incidence of hypocalcemia was higher in patients undergoing surgery for malignant thyroid ( P < 0.05). CONCLUSIONS: We do not consider PTH levels at 24 hours postoperatively as predictive of hypocalcemia.

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