scholarly journals Study of incidence of hypocalcaemia in patients undergoing total thyroidectomy for papillary carcinoma: a retrospective study

2021 ◽  
Vol 8 (9) ◽  
pp. 2746
Author(s):  
S. P. Gayathre ◽  
R. Niranjen Kumar ◽  
M. J. Prabu
Keyword(s):  
Total Thyroidectomy ◽  
Papillary Carcinoma ◽  
Serum Calcium ◽  
Thyroid Surgery ◽  
Common Complication ◽  
Papillary Thyroid ◽  
Postoperative Monitoring ◽  
Post Operative Period ◽  
Permanent Hypocalcemia ◽  
Calcium Measurement

Background: Hypocalcaemia following total thyroidectomy is a fairly common complication. Occurrence of acute hypocalcaemia can be predicted in patients undergoing thyroid surgery for malignancy, based on serial calcium measurement and this helps in early prediction of hypocalcaemia. The aim of the study was to assess the incidence of post thyroidectomy hypocalcaemia and methods to treat hypocalcaemia and prevention of its complication at the earliest.Methods: The incidence of hypocalcemia was analysed with serial calcium estimation in immediate post-operative period, 4 hours and 24 hours after surgery and on 5th post-operative day. The factors analysed included pre-operative and post-operative serum calcium levels, clinical features, the disease type and factors related to surgery and histopathologically diagnosis as malignant papillary thyroid carcinoma is confirmed.Results: In this study 30 patients underwent total thyroidectomy for papillary carcinoma were studied. Incidence of 22% of hypocalcemia, with transient hypocalcemia in 20% and permanent hypocalcemia in 2% of cases were noted.  Conclusions: Patients underwent thyroid surgery for malignant conditions showed higher incidence and severity hypocalcaemia. This complication can be prevented with meticulous peroperative dissection, prompt identification of parathyroid gland. Avoiding injury or spasm of the blood vessels supplying them and frequent postoperative monitoring of serum calcium levels. 

scholarly journals A study of monitoring of early postoperative serum calcium levels in total thyroidectomy and its role in predicting temporary or permanent hypocalcemia: a prospective observational study

2020 ◽  
Vol 7 (3) ◽  
pp. 697
Author(s):  
Suryanarayana Reddy V. ◽  
Ashrith Reddy Cheruku ◽  
Rammohan Cheeti ◽  
Vivek Acha ◽  
Prashanth Gunde
Keyword(s):  
Observational Study ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Prospective Observational Study ◽  
Post Operative Period ◽  
Permanent Hypocalcemia ◽  
Postoperative Serum ◽  
The Mean ◽  
Postoperative Hypocalcaemia

Background: This aim of study was to evaluate the ability of consecutive measurements of serum calcium levels to predict clinically relevant post-thyroidectomy hypocalcaemia and to assess risk factors for post-thyroidectomy hypocalcaemia.Methods: The study design was a prospective observational study, total 65 patients who undergoing completion or total thyroidectomy. Serum calcium level was measured at the time of first follow up (nearly 20th postoperative day) and patient was examined for signs of hypocalcemia.Results: In this study, 65 patients of all age group included from 19 years to 78 years. The mean (±SD) age of the patients was 47.65±12.35 years with range from 19 to 78 years. The mean difference of calcium values after 6 hours, 12 hours, 24 hours and 48 hours post-operative period were statistically significant (p<0.001) between patients with hypocalcaemia and patient with normokalaemia in unpaired t-test.Conclusions: There was no significant increase in morbidity (including postoperative hypocalcaemia) in completion thyroidectomy compared to primary total thyroidectomy.

Cervical thyroid remnant consistent with papillary carcinoma as an incidental finding in a patient with benign total thyroidectomy ten years prior

2019 ◽  
Vol 91 (4) ◽  
pp. 1-3
Author(s):  
Adriana Ruano Campos ◽  
Daniel Rivera Alonso ◽  
Santiago Ochagavía Cámara
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Total Thyroidectomy ◽  
Papillary Carcinoma ◽  
Cervical Lesion ◽  
Needle Puncture ◽  
Papillary Thyroid ◽  
Thyroid Remnant ◽  
Fine Needle ◽  
Fine Needle Puncture

Background: Differential diagnosis of a cervical lesion corresponding with papillary thyroid carcinoma (PTC) after benign total thyroidectomy can be a real challenge. Methods: A cervical thyroid remnant compatible with papillary carcinoma was incidentally found ten years after total thyroidectomy for a non-functional multinodular goitre. Histological analysis of fine needle puncture aspiration (FNPA) was highly suggestive for PTC. Surgical excision of the cervical lesion was performed. Specimen study demonstrated a classic variant of PTC contacting a peripheral margin, applying ablative treatment with radioactive iodine postoperatively. Results: The patient did not present signs of recurrence during follow-up. Small thyroid remnants after benign thyroidectomy are often left behind, although their risk of malignancy is exceptional. Conclusions: It is important to individualize therapeutic approach when facing this rare entity. We decided to treat the patient by removing the lesion followed by ablation therapy with successful results. PTC: Papillary thyroid carcinoma FNPA: Fine needle puncture aspiration

scholarly journals Study of the incidence of hypocalcemia in patients undergoing bilateral thyroid surgery

2020 ◽  
Vol 7 (9) ◽  
pp. 2914
Author(s):  
Baleshwar Dhiman ◽  
Satish Dalal ◽  
Nityasha Dalal ◽  
Sethu Raman
Keyword(s):  
Serum Calcium ◽  
Thyroid Surgery ◽  
Thyroid Disease ◽  
Study Data ◽  
P Value ◽  
Chi Square ◽  
Ethical Approval ◽  
Chi Square Test ◽  
Calcium Measurement ◽  
Benign Thyroid

Background: Thyroid surgery are among the most common operations performed all over the world. Hypocalcemia following total thyroidectomy is a fairly common complication. Occurrence of acute hypocalcemia can be predicted in patients undergoing thyroid surgery, based on serial calcium measurement and this helps in early prediction of hypocalcemia. The aim of present study was to assess the incidence of post thyroidectomy hypocalcemia and factors which might play a role in its occurrence.Methods: A total 30 patients who underwent bilateral thyroidectomy were analysed. The study period was from June 2017 to March 2019. The incidence of hypocalcemia was analysed with serial calcium estimation in immediate post-operative period, 4 hours and 24 hours after surgery and on 5th post-operative day. The factors analysed included pre-operative and post-operative serum calcium levels, clinical features, the disease type and factors related to surgery. The ethical approval was taken from the ethical committee of the institute. At the end of the study data was collected and analysed by using student t-test and chi square test. A p-value of less than 0.05 was considered significant.Results: Post-operative transient hypocalcemia developed in 21 patients out of 30 (70%). Of them six patients (28.75%) developed severe hypocalcemia and 15 (71.42%) developed mild to moderate hypocalcemia. Out of six patients, five patients were histopathologically diagnosed as malignant thyroid disease. 15 patients who developed mild to moderate hypocalcemia were diagnosed to be having benign thyroid conditions.Conclusions: Patients underwent thyroid surgery for malignant conditions showed higher incidence and severity hypocalcemia as compared to cases where surgery was performed for benign thyroid disease. This complication can be prevented with meticulous perioperative dissection, prompt identification of parathyroid glands and frequent postoperative monitoring of serum calcium levels.

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 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.

scholarly journals A challenging TSH/GH co-secreting pituitary adenoma with concomitant thyroid cancer; a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jee Hee Yoon ◽  
Wonsuk Choi ◽  
Ji Yong Park ◽  
A Ram Hong ◽  
Sung Sun Kim ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Pituitary Adenoma ◽  
Total Thyroidectomy ◽  
Thyroid Surgery ◽  
Pituitary Tumor ◽  
Oral Glucose ◽  
Somatostatin Analogue ◽  
Papillary Thyroid ◽  
Α Subunit

Abstract Background Thyroid stimulating hormone (TSH) secreting pituitary adenoma (TSHoma) with coexisting thyroid cancer is extremely rare, and proper treatment of both diseases may pose a unique clinical challenge. When TSHoma has plurihormonality, particularly involving the co-secretion of growth hormone (GH), management can be more complicated. Herein, we present a difficult-to-manage case of papillary thyroid cancer with an incurable TSH/GH-secreting pituitary adenoma. Case presentation A 59-year-old man was referred to our hospital due to memory impairment and inappropriate TSH level. Sella magnetic resonance imaging revealed a huge pituitary mass extending to the suprasellar area. Clinical diagnosis of TSH/GH co-secreting pituitary adenoma was made based on elevated free T4, total T3, serum α-subunit, insulin-like growth factor-1 levels and non-suppressible GH levels after oral glucose loading. Rectal cancer and multifocal papillary thyroid microcarcinoma (PTMC) were diagnosed during initial screening for internal malignancy; lower anterior resection was performed and close observation was planned for PTMC. Long-acting octreotide therapy was commenced, which resulted in a dramatic reduction in TSHoma size and facilitated control of hormonal excess. Total thyroidectomy and radioactive iodine (RAI) therapy were needed during follow up due to the growth of PTMC. After the surgery, the pituitary adenoma represented resistance to somatostatin analogue therapy and the tumor size gradually increased despite the addition of dopamine agonist therapy. Furthermore, TSH suppressive therapy with levothyroxine was impossible and an adequate TSH level for RAI therapy was unmountable. Late debulking pituitary surgery was ineffective, and the patient gradually deteriorated and lost to follow up. Conclusion We report the first aggravated case of TSH/GH co-secreting pituitary tumor after total thyroidectomy for concomitant multifocal PTMC. Deferring of thyroid surgery until the TSHoma is well controlled may be the optimal therapeutic strategy in patients with TSHoma and coexistent thyroid cancer; ablative thyroid surgery may result in catastrophic pituitary tumor growth.

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.

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.

Multifocal Micropapillary Thyroid Cancer: A New Indication for Total Thyroidectomy?

2012 ◽  
Vol 78 (11) ◽  
pp. 1211-1214 ◽  
Author(s):  
Joel A. Ricci ◽  
Antonio E. Alfonso
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Tumor Size ◽  
Young Patients ◽  
American Thyroid Association ◽  
Recurrent Nerve ◽  
Papillary Thyroid ◽  
Nerve Injuries ◽  
Permanent Hypocalcemia ◽  
Well Differentiated

American Thyroid Association guidelines recommend total thyroidectomy (TT) for thyroid cancers 1 cm or greater. Liberal use of neck sonography has resulted in an increased incidence of papillary cancers detected at earlier stages with approximately half at the micropapillary level and occasionally multifocal. Concerns regarding the safety of routine TT, especially in young patients with favorable cancers, and the clinical significance of detected multifocal micropapillary cancers have been raised. Records of 516 consecutively treated patients with thyroid cancer were reviewed. A subset of 269 cases with well-differentiated papillary thyroid cancer (WDPTC) confined within the capsule of the involved lobe undergoing TT was analyzed. Patients were stratified according to age, tumor size, evidence of ipsilateral multifocality, and presence or absence of contralateral nonpalpable malignancy. Overall contralateral histologic malignancy was demonstrated in 46.4 per cent (125 of 269). The incidence was 34 per cent (30 of 88) of subcentimeter (less than 1 cm) tumors and significantly increased to 52 per cent (95 of 181) in tumors 1 cm or greater ( P = 0.006). This incidence significantly approached 76 per cent (13 of 17) in subcentimeter but multifocal tumors when 45 years or older ( P = 0002). One patient developed permanent hypocalcemia (0.4%). There were no recurrent nerve injuries. The incidence of bilateral cancer was significant in 1-cm or greater WDPTC. Patients with subcentimeter multifocal tumors, when older than 45 years, were even at higher risk for bilateral cancer. Because TT is advocated for patients with WDPTC 1 cm or greater, it should also be considered in those older than 45 years with ipsilateral multifocal micropapillary cancers, because it can be performed safely.

Profound hypocalcaemia associated with bilateral cataracts post-total thyroidectomy

2007 ◽  
Vol 44 (4) ◽  
pp. 400-402 ◽  
Author(s):  
Danielle B Freedman ◽  
Natalie Smith ◽  
David Housley
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Thyroid Surgery ◽  
Uncommon Presentation ◽  
History Of

Profound hypocalcaemia is an uncommon presentation from primary care. We describe a case of hypocalcaemia presenting 4 years after total thyroidectomy. Long-term complications of chronic hypocalcaemia are rarely seen in clinical practice today, but had occurred in this case with the development of bilateral cataracts. All patients should be monitored following thyroidectomy to ensure that hypocalcaemia does not persist. In addition to this, patients with a history of thyroid surgery presenting with cataracts should have serum calcium measured.

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