scholarly journals Causes of hypocalcemia after thyroid surgery

2020 ◽  
Vol 101 (2) ◽  
pp. 206-211
Author(s):  
A F Hummatov ◽  
A H Abbasov ◽  
A K Ismayilov ◽  
E M Gasymov
Keyword(s):  
Total Thyroidectomy ◽  
Nodular Goiter ◽  
Early Postoperative Period ◽  
Test Results ◽  
Postoperative Hypocalcemia ◽  
Parathyroid Autotransplantation ◽  
The Third ◽  
Repeated Surgery ◽  
Permanent Hypocalcemia ◽  
Median Test

Aim. To identify the causes affecting hypocalcemia and its frequency of causing after thyroidectomy. Methods. The study included 402 patients after thyroidectomy, 361 (89.8%) women and 41 (10.2%) men, for the period 20152019. The patients were between the ages of 14 and 77 years (average 4527.2 years). Patients were tested for the presence of hyperthyroidism, the volume of tissue removed and type of thyroidectomy, presence of repeated thyroid operations and accidental parathyroidectomy, the results of parathyroid autotransplantation and pathohistological reports. To determine the effect of these factors on hypocalcemia, patients were divided into three groups. The first group included patients (n=51, 12.7%) were underwent surgery for Graves disease, the second (n=335, 83.3%) for nodular goiter, and the third (n=16, 4%) for recurrent goiter. Statistical data analysis was performed with IBM SPSS 16.0. The results were analyzed by one-way analysis of variance or KruskalWallis test and the median test. Results were considered statistically significant at p 0.05 (two-sided criterion). Results. In the early postoperative period, 20 (5%) of 402 patients had hypocalcemia, of which 12 (3%) had transient hypocalcemia, and 8 (2%) had permanent hypocalcemia. Postoperative hypocalcemia was detected in 9 (17.6%) patients the first group, 8 (2.4%) patients in the second group, and 3 (18.8%) patients of the third group. Patients hypocalcemia was characterized based on the types of underwent operations as follows: in 14 (5.3%; p 0.05) patients after total thyroidectomy, in 1 (3.2%) patient after close to total thyroidectomy, in 1 (16.7%) patient after total thyroidectomy with central lymphatic dissection, in 1 (20%) patient after total thyroidectomy with central and lateral lymphatic dissection, in 3 (18.8%) patients after repeated surgery. Postoperative hypocalcemia was identified in 5 of 44 patients of the second group with thyroid carcinoma, as well as in 1 patient of the third group with the same pathology (p=0.246). Conclusion. Incidence of hypocalcemia was more frequent after surgery for hyperthyroidism, especially after total thyroidectomy; in 40% of cases, transient hypocalcemia was identified in patients with autotransplantation of the parathyroid gland after an accidental parathyroidectomy.

A Cohort Study Assessing the Association Between Body Composition Parameters and Symptomatic Hypocalcemia After Total Thyroidectomy

2020 ◽  
pp. 000313482097957
Author(s):  
Suleyman U. Celik ◽  
Can Konca ◽  
Volkan Genc
Keyword(s):  
Body Composition ◽  
Total Thyroidectomy ◽  
Clinical Symptoms ◽  
The Body ◽  
Postoperative Hypocalcemia ◽  
Parathyroid Autotransplantation ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Symptomatic Hypocalcemia ◽  
The Relationship

Background Postoperative hypocalcemia is one of the major concerns following thyroidectomy and the most frequent cause of prolonged hospital stay. The aim of this study was to evaluate the relationship between body composition parameters and symptomatic hypocalcemia following total thyroidectomy. In addition, the effects of disease- and patient-related factors on hypocalcemia were investigated. Methods A total of 144 patients were prospectively included between March 2014 and September 2017. Patients were divided into 2 groups according to the presence or absence of clinical symptoms of hypocalcemia. Subsequently, the relationship between body composition parameters and hypocalcemia was evaluated. Results Postoperative hypocalcemia-related symptoms occurred in 28 patients (19.4%). Permanent hypocalcemia was not encountered in any patient. Patients with hypocalcemic symptoms were more likely to have nodules ≥40 mm (39.3% vs. 17.2%, P = .011), retrosternal goiters (25.0% vs. 7.8%, P = .017), central lymph node dissection (LND) (32.1% vs. 11.2%, P = .015), and parathyroid autotransplantation (28.6% vs. 3.4%, P < .001) than those without symptoms. However, no differences were observed in the body composition parameters between symptomatic and asymptomatic patients. On multivariate analysis, lower preoperative intact parathyroid hormone (iPTH) levels (odds ratios (ORs) .96, 95% confidence intervals (CIs) .93-.99), the presence of retrosternal goiters (OR 10.26, 95% CI 2.23-47.14), central LND (OR 16.05, 95% CI 3.90-66.07), and parathyroid autotransplantation (OR 36.22, 95% CI 6.76-194.13) predicted hypocalcemia. Discussion This study demonstrates that patients with lower preoperative iPTH levels, retrosternal goiters, central LND, and parathyroid autotransplantation are at an increased risk of developing clinical symptoms of hypocalcemia. Body composition parameters have no effect on the incidence of hypocalcemia after total thyroidectomy.

scholarly journals Timing of hypocalcemia after total or near total thyroidectomy: a prospective observational study

2020 ◽  
Vol 7 (4) ◽  
pp. 977
Author(s):  
Mohamed O. Benkhadoura ◽  
Abdulwahab M. Elbarsha ◽  
Khaled K. Elgazwi ◽  
Akrem I. Elshaikhy ◽  
Talal K. Elkhweldi ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Prospective Observational Study ◽  
Early Discharge ◽  
University Hospitals ◽  
Postoperative Hypocalcemia ◽  
The Third ◽  
Metabolic Complication ◽  
Serial Serum ◽  
Calcium Measurement

Background: Hypocalcemia after thyroidectomy is the most common metabolic complication that prolongs the hospital stay. The aim of this study was to determine timing of hypocalcemia postoperatively and determine the safest day to discharge post-total or near-total thyroidectomy patients based on serum calcium level.Methods: From October 2012 to January 2017, the medical records of 117 consecutive patients who underwent a total or near-total, completion or redo thyroidectomy for benign and malignant thyroid diseases in two university hospitals were prospectively analyzed. The serum calcium was measured preoperatively, on the morning on the first, second, third and fourth postoperative days and the postoperative day on which hypocalcemia developed was identified.Results: Of the 117 patients who underwent a total or near thyroidectomy, 36 (30.7%) developed hypocalcemia, which was transient in 34 (29%) and permanent in two (1.7%) patients. The postoperative hypocalcemia was mild in 10 (8.5%) patients, and 26 (22.2%) patients developed significant postoperative hypocalcemia. Of the 36 patients who developed hypocalcemia postoperatively, the peak incidence of hypocalcemia (72.2%) was on the first postoperative day, and by the third day serum calcium measurement detected 97.3% of patients who developed hypocalcemia.Conclusions: Postoperative serial serum calcium levels may be useful for identifying patients suitable for early discharge following total/near total thyroid surgery in hospitals that lack the facilities. Hypocalcemia peaked on the first postoperative day. However, based on serum calcium levels alone, the third postoperative day is the crucial day for deciding whether to discharge the patients.

scholarly journals A Meta-Analysis of Risk Factors for Transient and Permanent Hypocalcemia After Total Thyroidectomy

2021 ◽  
Vol 10 ◽  
Author(s):  
Yuan Qin ◽  
Wei Sun ◽  
Zhihong Wang ◽  
Wenwu Dong ◽  
Liang He ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Vitamin D Deficiency ◽  
Meta Analysis ◽  
Parathyroid Autotransplantation ◽  
Central Lymph Node Dissection ◽  
Newcastle Ottawa Scale ◽  
Permanent Hypocalcemia

BackgroundAs hypocalcemia is the most common complication of total thyroidectomy, identifying its risk factors should guide prevention and management. The purpose of this study was to determine the risk factors for postthyroidectomy hypocalcemia.MethodsWe searched PubMed, Web of Science and EMBASE through January 31, 2019, and assessed study quality using the Newcastle–Ottawa Scale.ResultsFifty studies with 22,940 patients met the inclusion criteria, of which 24.92% (5716/22,940) had transient hypocalcemia and 1.96% (232/11,808) had permanent hypocalcemia. Significant (P &lt; 0.05) predictors of transient hypocalcemia were: younger age, female, parathyroid autotransplantation (PA), inadvertent parathyroid excision (IPE), Graves’ disease (GD), thyroid cancer, central lymph node dissection, preoperative severe Vitamin D deficiency, preoperative Vitamin D deficiency and a lower postoperative 24 h parathyroid hormone (PTH) level. Preoperative magnesium, preoperative PTH and Hashimoto’s thyroiditis were not significant predictors of transient hypocalcemia. IPE, GD, and thyroid cancer were associated with an increased rate of permanent hypocalcemia, but gender and PA did not predict permanent hypocalcemia.ConclusionImportant risk factors for transient and permanent hypocalcemia were identified. However, given the limited sample size and heterogeneity of this meta-analysis, further studies are required to confirm our preliminary findings.

scholarly journals HYPOCALCEMIA IN TOTAL VERSUS SUBTOTAL THYROIDECTOMY

2021 ◽  
Vol 71 (Suppl-3) ◽  
pp. 630-33
Author(s):  
Tahira Sajid ◽  
Syeda Rifaat Qamar Naqvi ◽  
Zara Sajid ◽  
Fatima Sajid ◽  
Ismail Akbar ◽  
...  
Keyword(s):  
Prospective Study ◽  
Total Thyroidectomy ◽  
Nodular Goiter ◽  
Subtotal Thyroidectomy ◽  
Military Hospital ◽  
Increased Risk ◽  
Significant Difference ◽  
Permanent Hypocalcemia ◽  
Group 2 ◽  
Comparative Prospective Study

Objective: To compare the occurrence of hypocalcemia in patients undergoing subtotal and total thyroidectomy. Study Design: Comparative prospective study. Place and Duration of Study: Surgical departments of Ayub Teaching Hospital, Abbottabad and Combined Military Hospital, Rawalpindi, from Mar 2018 to Feb 2020. Methodology: A total of 171 patients were selected for this study and they were divided into 2 groups. Group 1 consisted of 95 patients undergoing Total thyroidectomy whereas group 2 had 76 patients undergoing Subtotal thyroidectomy. It was a comparative prospective study and the groups were made by convenience sampling. The data was analyzed by SPSS-23. Results: In total thyroidectomy group Hypocalcemia was detected after 48 hours in 34 patients (35%) while in subtotal thyroidectomy group hypocalcemia was detected in 20 patients (28%). Tests for hypocalcemia were also done after two months of surgery and low levels were detected in 7 patients (7.5%) who had total thyroidectomy and in 2 patients (5%) in the group undergoing subtotal thyroidectomy. There was no significant difference in hypocalcemia after 48 hour (p=0.22) and 2 months postoperatively (p=0.6) between patients of Total Thyroidectomy and Subtotal Thyroidectomy. Conclusion: Total thyroidectomy is not associated with increased risk of permanent hypocalcemia as compared to Subtotal thyroidectomy. Because of its advantages Total thyroidectomy should be the preferred surgical procedure for patients presenting with benign euthyroid multi nodular goiter.

scholarly journals Hypocalcemia and Hoarseness Following Total Thyroidectomy for Benign Disease: Relationship of Incidence to the Size of the Gland

2011 ◽  
Vol 3 (1) ◽  
pp. 7-9 ◽  
Author(s):  
R Fernando ◽  
PC Chandrasinghe ◽  
M Bandara
Keyword(s):  
Postoperative Complications ◽  
Thyroid Gland ◽  
Total Thyroidectomy ◽  
Surgical Procedure ◽  
Significant Risk ◽  
Benign Disease ◽  
Postoperative Hypocalcemia ◽  
Significant Difference ◽  
Permanent Hypocalcemia ◽  
Relationship Of

ABSTRACT Introduction Total thyroidectomy is considered as the standard surgical procedure for most malignancies and benign disease involving both lobes of the thyroid gland. Postoperative complications are likely to be commoner when the thyroid gland is large in size due to the alteration of structural anatomy. Methods Postoperative complications of 102 patients who underwent total thyroidectomy for benign disease, by the same surgeon, were analyzed. Patients were prospectively followed up and presence of hoarseness and hypocalcemia, both transient and temporary, were compared with the weight of the gland. Results Fourteen patients developed hypocalcemia of which 12 (11.7%) had transient and 2 (1.96%) had permanent deficiencies. Eight patients developed hoarseness following surgery of which seven (6.86%) had transient and only one (0.98%) had permanent hoarseness. A mean thyroid weight of 91.78 gm was observed in the uncomplicated group. Those who developed postoperative hypocalcemia and transient hoarseness had a mean thyroid weight over 100 gm. One patient, who had a thyroid weighing 195 gm developed permanent hoarseness due to RLN injury. Conclusion There is no statistically significant difference in the incidence of transient RLN and transient or permanent hypocalcemia. With increased size of the thyroid gland increased rate of complications was observed with a mean thyroid weight above 100 gm. There may be a significant risk of permanent RLN injury when the thyroid gland is enlarged over 10 times (closer to 200 gm) its normal size.

scholarly journals COVID-19 and pregnancy – where are we now? A review

2020 ◽  
Vol 48 (5) ◽  
pp. 428-434 ◽  
Author(s):  
Aleksandra Rajewska ◽  
Wioletta Mikołajek-Bedner ◽  
Joanna Lebdowicz-Knul ◽  
Małgorzata Sokołowska ◽  
Sebastian Kwiatkowski ◽  
...  
Keyword(s):  
Case Fatality ◽  
Fetal Distress ◽  
Delivery Mode ◽  
Test Results ◽  
Rt Pcr ◽  
Third Trimester ◽  
The Third ◽  
Laboratory Test Results ◽  
Protective Antibodies ◽  
Polymerase Chain

AbstractThe new acute respiratory disease severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is highly contagious. It has caused many deaths, despite a relatively low general case fatality rate (CFR). The most common early manifestations of infection are fever, cough, fatigue and myalgia. The diagnosis is based on the exposure history, clinical manifestation, laboratory test results, chest computed tomography (CT) findings and a positive reverse transcription-polymerase chain reaction (RT-PCR) result for coronavirus disease 2019 (COVID-19). The effect of SARS-CoV-2 on pregnancy is not already clear. There is no evidence that pregnant women are more susceptible than the general population. In the third trimester, COVID-19 can cause premature rupture of membranes, premature labour and fetal distress. There are no data on complications of SARS-CoV-2 infection before the third trimester. COVID-19 infection is an indication for delivery if necessary to improve maternal oxygenation. Decision on delivery mode should be individualised. Vertical transmission of coronavirus from the pregnant woman to the fetus has not been proven. As the virus is absent in breast milk, the experts encourage breastfeeding for neonatal acquisition of protective antibodies.

Dimensioning the Flexural Strengthening of Concrete Slabs with Textile Reinforced Mortar - Litterature Data Evaluation

2018 ◽  
Author(s):  
Alex-Manuel Muresan ◽  
Daia Zwicky
Keyword(s):  
Concrete Slabs ◽  
Test Results ◽  
Structural Concrete ◽  
Bond Behaviour ◽  
Flexural Strengthening ◽  
The Third ◽  
Reinforced Concrete Slabs ◽  
Main Challenge ◽  
External Reinforcement ◽  
Textile Reinforced Mortar

When strengthening reinforced concrete slabs with textile reinforced mortars (TRM), the “correct” consideration of the global bond behaviour between textile and cementitious matrix is identified as the main challenge in determining the most appropriate global analytical model. The first model evaluated here is based on classical assumptions for structural concrete design. The second model, as another extreme assumption, is completely neglecting textile bond in the cracked zone, thus assuming it as unbonded, end-anchored, external reinforcement. The third model is based on the simplifying assumption of the textile reinforcement being only significantly activated when the internal steel reinforcement is yielding. Analytical results from these approaches are compared to a database containing more than 130 test results reported in literature, and are statistically evaluated.

scholarly journals The impact of postoperative percent change of parathormone level from baseline value on the rate of hypocalcemia after total thyroidectomy

2017 ◽  
Author(s):  
Ismail Cem Sormaz ◽  
Ahmet Yalin Iscan ◽  
Ilker Ozgur ◽  
Seyma Karakus ◽  
Fatih Tunca ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Albumin Concentration ◽  
Postoperative Hypocalcemia ◽  
Percent Change ◽  
Number Of Patients ◽  
Increased Risk ◽  
Symptomatic Hypocalcemia ◽  
Postoperative Serum ◽  
Group 2 ◽  
The Impact

Background: To investigate the impact of the percent change of postoperative parathormone (PoPTH) level from baseline value (∆PTH) on the rate of hypocalcemia after total thyroidectomy. Methods: Assays of serum PTH and calcium (Ca) were performed preoperatively and at 24 hours postoperatively in 222 consecutive patients who underwent total thyroidectomy. Postoperative hypocalcemia was defined as serum calcium level corrected for albumin concentration (cCa) &lt;8.5mg/dl. Patients with postoperative hypocalcemia were classified as group1 (n=100) and those with normal Ca levels as group 2 (n=122). The PoPTH levels and ∆PTH were compared between the two groups. ROC analysis was performed to determine the cut off values for PoPTH and ∆PTH. Results: The mean PoPTH level was significantly lower in group 1 compared to group 2 (18.6±15.3 pg/ml vs 32.3±15.6 pg/ml, respectively; P&lt;0.0001). PoPTH values were within normal range in 54% of the patients with hypocalcemia and 35% of those with symptomatic hypocalcemia. PoPTH &lt;28pg/ml or ∆PTH &gt;45 were significantly associated with increased risk of post-thyroidectomy hypocalcemia (P=0.0001). A ∆PTH &gt;70% ,PoPTH ≤ 15.5pg/ml and postoperative serum cCa concentrations&lt;8.0mg/dl significantly predicted symptomatic hypocalcemia(P=0.009;P=0.006;andP=0.0001;respevtively).The sensitivities of ∆PTH,PoPTH level and postoperative serum cCa concentration to predict symptomatic hypocalcemia were 67%,64% and100, respectively. Conclusion: Although, PTH decline significantly correlate with symptomatic hypocalcemia, a considerable number of patients may experience hypocalcemic symptoms in spite of normal PoPTH levels. Analysis of serum Ca concentrations at 24 hours postoperatively help to achieve a more precise prediction of patients who bear a high risk for developing hypocalcemic symptoms.

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