Hypocalcaemia after Total Thyroidectomy

Objective: To determine whether postoperative hypocalcemia after total thyroidectomy is more frequent in malignant disease than benign disease. Methods: This is a Cross sectional study. The sample size is 126. All the patients were selected according to the eligibility criteria by purposive sampling. Patients were analyzed for age, gender, thyroid pathology, preoperative serum calcium, postoperative serum calcium. Results: Postoperative hypocalcemia was found in 37 (29.37%) patients. Most patients were female (Male: Female= 1: 4.2). Patients having low preoperative serum calcium had developed more postoperative hypocalcemia (p<0.03). Postoperative hypocalcemia was associated with thyroid pathology (p<0.009) and age (p<0.006), not associated with sex (p<0.907). In multivariate analysis very little association between malignant disease and postoperative hypocalcemia was found (p<0.07). Conclusion: The incidence of postoperative hypocalcemia following total thyroidectomy is 29.4% that is higher than the anticipated but is comparable to other published series. For total thyroidectomy surgeons should be aware of postoperative hypocalcemia but prophylactic calcium and vitamin D supplement is not mandatory in all cases. Bangladesh J Otorhinolaryngol; April 2019; 25(1): 19-27

Download Full-text

Is serum phosphorous level an early indicator of post-operative hypocalcemia after total thyroidectomy? A prospective analysis

International Surgery Journal ◽

10.18203/2349-2902.isj20213972 ◽

2021 ◽

Vol 8 (10) ◽

pp. 2935

Author(s):

Antony P. Thachil ◽

Carbin S. Joseph ◽

Sandeep Kumar S. David

Keyword(s):

Total Thyroidectomy ◽

Serum Calcium ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cross Sectional Study ◽

Care Hospital ◽

Postoperative Hypocalcemia ◽

Cross Sectional ◽

Potential Marker ◽

Phosphorous Level

Background: Total thyroidectomy is a commonly performed surgery. Postoperative hypocalcemia is a worrisome complication which can be treated if recognized early. We analysed serum phosphorous as a potential marker of postoperative hypocalcemia.Methods: The study was a cross-sectional study done in our tertiary care hospital. We analysed the serum phosphorous levels of 50 patients who underwent total thyroidectomy at our institution. The incidence of hypocalcemia was documented and analysed with respect to serum phosphorous.Results: In the study, 18 (36%) had hypocalcaemia on third postoperative day and 32 (64%) had no hypocalcaemia. There was no relation between post thyroidectomy day one serum phosphorus value and post-thyroidectomy day three serum calcium value (p=0.709).Conclusions: The study did not find any statistically significant association between serum phosphorous and post-thyroidectomy serum calcium levels.

Download Full-text

Frequency of Hypocalcaemia following total Thyroidectomy

10.53350/pjmhs211592863 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2863-2866

Author(s):

Wardah Mumtaz ◽

Umar Rehman ◽

Arshid Mahmood ◽

Fazal-E- Nauman ◽

Kausar Shaikh ◽

...

Keyword(s):

Total Thyroidectomy ◽

Serum Calcium ◽

Signs And Symptoms ◽

Cross Sectional Study ◽

Inform Consent ◽

Cross Sectional ◽

Study Objective ◽

Surgical Department ◽

Thyroid Profile ◽

Age Range

Background: The most common post-thyroidectomy complication is hypocalcaemia. It could be permanent or transitory. Permanent hypocalcaemia has a prevalence of 0-13% and transient hypocalcaemia has a prevalence of 1-6%. Aim: The study objective was to ascertain the prevalence of postoperative hypocalcaemia in patients following total thyroidectomy. Materials and Methods: This cross-sectional study was carried out on 84 thyroid patients who underwent total thyroidectomy in the surgical department of HBS General Hospital, Islamabad for period of nine months during from September 2020 to May 2021. Patients within the age range of 15-69 years and had indicated thyroidectomy caused by carcinoma thyroid, multinodular goiter, and recurrent goiter were enrolled. Inform consent was obtained from each participant. Ethical approval was taken from the institutional ethical committee. Thyroid profile and serum calcium were done for a routine investigation. Serum calcium levels were measured 24 hours, 48 hours, and 7 days after total thyroidectomy. Signs and symptoms in hypocalcaemia patients were recorded on a proforma. Patients with hypocalcaemia were followed for six months. SPSS version 20 was used for data analysis. Results: The mean age of the patients was 46.7 ± 4.6 years with an age range of 16 to 69 years. Of the total 84 patients, 38 (45.2%) underwent total thyroidectomy and 46 (54.8%) underwent a complete thyroidectomy. The prevalence of male and female patients was 22 (26.2%) and 62 (73.8%) respectively. Malignant and benign were present in 71 (84.5%) and 13 (15.5%) respectively. Of the total 84 patients, 68 (81%) developed hypocalcaemia. Out of 68 hypocalcaemia patients, 29 (42.6%) and 39 (57.4%) were from the benign and malignant groups respectively. Conclusion: Postoperatively hypocalcaemia was prevalent following thyroidectomy. Malignant patients (84.5%) were more prevalent compared to benign patients (15.5%) after total thyroidectomy. Careful surgical procedures, parathyroid gland vascularity preservation, and identification are critical in preventing hypocalcaemia following total thyroidectomy. Keywords: Hypocalcaemia; Total thyroidectomy; Complete Thyroidectomy

Download Full-text

Vitamin D Deficiency as a Predictive Factor of Transient Hypocalcemia after Total Thyroidectomy

International Journal of Endocrinology ◽

10.1155/2020/8875257 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

A. Bove ◽

C. Dei Rocini ◽

R. M. Di Renzo ◽

M. Farrukh ◽

G. Palone ◽

...

Keyword(s):

Vitamin D ◽

Total Thyroidectomy ◽

Vitamin D Deficiency ◽

Serum Calcium ◽

Predictive Factor ◽

Postoperative Hypocalcemia ◽

Independent Predictive Factor ◽

Preoperative Serum ◽

Group 2 ◽

Group 1

Background. Total thyroidectomy (TT) is recommended in the treatment of malignant and benignant thyroid diseases, and, to date, transient hypocalcemia is the most frequent complication after the procedure. We prospectively evaluated the role of vitamin D deficiency as a predictor of postoperative hypocalcemia. Methods. This is a prospective cohort study which was conducted between January 2016 and April 2019. A total of 177 consecutive patients (141 (79.7%) women and 36 (20.3%) men) who underwent TT were included in the current study. Hypocalcemia occurred when serum calcium levels were below 8.0 mg/dL or 1.10 mmol/L. Patients were divided into two groups (Group 1, normocalcemic; Group 2, hypocalcemic) and were assessed taking into consideration preoperative serum 25-hydroxy vitamin D (25-OHD) levels, preoperative serum calcium levels, thyroid hormone levels, sex, body mass index (BMI), and smoking habits. Vitamin D deficiency was defined as 25-OHD levels <25 ng/mL. Results. The incidence of postoperative asymptomatic and symptomatic hypocalcemia in the two groups was 19.8% and 15.8%, respectively. Preoperative 25-OHD level was significantly different between Group 1 and Group 2 (31.5 ± 15.0 ng/mL vs 18.7 ± 9.8 ng/mL,p=0.017). Logistic regression analysis revealed that preoperative vitamin D deficiency was a significant predictive factor of postoperative hypocalcemia (p=0.012), and, specifically, the risk of hypocalcemia increased 15-fold in patients with a preoperative vitamin D level <25 ng/mL (odds ratio [OR], 14.8). Conclusions. Postoperative hypocalcemia is significantly associated with low preoperative levels of serum 25-OHD. Our studies demonstrate that vitamin D deficiency (<25 ng/mL) is an independent predictive factor of postoperative hypocalcemia.

Download Full-text

The prescription pattern and awareness about antibiotic prophylaxis and resistance among a group of Egyptian pediatric and general dentists: a cross sectional study

BMC Oral Health ◽

10.1186/s12903-021-01685-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mariam Mohsen Aly ◽

Marwa Aly Elchaghaby

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Prophylaxis ◽

Antibiotic Prescription ◽

Public Health Problem ◽

Cross Sectional Study ◽

Major Public Health Problem ◽

Eligibility Criteria ◽

Cross Sectional ◽

Validated Questionnaire ◽

General Dentists

Abstract Background The use of antibiotics in dentistry as prophylaxis and treatment is frequent. Their misuse has led to a major public health problem globally known as antibiotic resistance. This study aimed to assess the pattern of antibiotic prescription and its prophylactic use for systemic conditions. Besides, this study evaluated the awareness and adherence to antibiotic prescription guidelines and antibiotic prophylaxis guidelines along with awareness of antibiotic resistance across pediatric and general dentists. Methods An overall of 378 pediatric and general dentists meeting the required eligibility criteria, fulfilled a pre-designed validated questionnaire. Data were collected, tabulated, and statistically analyzed. Results A significant statistical difference was found among the pediatric and general dentists regarding antibiotics prescription for most of the oral conditions where Amoxicillin with clavulanic acid was the most frequently prescribed antibiotic among the two groups (53% pediatric dentist and 52% general dentist). The majority of pediatric and general dentists, on the other hand, were aware of antibiotic resistance and prescribing recommendations. Conclusions The present study showed a tendency to overprescribe and overuse antibiotics in certain dental conditions among the participants. The vast majority of dentists, especially general dentists do not have adherence to professional guidelines for antibiotics prescription in children despite their awareness of antibiotic resistance and prescription guidelines.

Download Full-text

Phototherapy Induced Hypocalcemia in Neonates with Unconjugated Hyperbilirubinemia

Journal of Bahria University Medical and Dental College ◽

10.51985/gubk9588 ◽

2021 ◽

Vol 11 (1) ◽

pp. 4-8

Author(s):

Amna Khan ◽

Anila Farhat ◽

Hamayun Anwar ◽

Sajid Shamim ◽

Mujeeb Ur Rehman ◽

...

Keyword(s):

Serum Calcium ◽

Calcium Level ◽

Serum Calcium Level ◽

Neonatal Intensive Care ◽

Cross Sectional Study ◽

Categorical Variables ◽

P Value ◽

Cross Sectional ◽

Unconjugated Hyperbilirubinemia ◽

Before And After

Objective: To determine the frequency of hypocalcemia in neonates with unconjugated hyperbilirubinemia receivingphototherapy.Study design and setting: Cross sectional study conducted at neonatal intensive care unit, King Abdullah Teaching Hospital,Mansehra for one year from December 2017 to November 2018.Methodology: Total 213 full term stable neonates of either gender with jaundice were studied in this study. Out of which,143 with unconjugated hyperbilirubinemia were exposed to phototherapy while 70 neonates with exaggerated physiologicalhyperbilirubinemia taken as control were not exposed to phototherapy. Serum calcium level was determined through bloodtest before and after 24 hours of phototherapy. SPSS version 22 was used to analyze the data. Frequency and percentageswere used to describe categorical variables like gender and hypocalcemia. Hypocalcemia was stratified by age and genderto see effect modifiers. Post stratified chi-square test was applied in which p value = 0.05 was considered as significancevalue.Results: In study group, 143 neonates who received phototherapy had mean age of 7 days ± 2.62 SD. Total 65% neonateswere male and 35% neonates were female. Mean serum calcium level of neonates before and after provision of phototherapywas 9.28 mg/dl ± 0.23 and 8.54 mg/dl ± 0.68 respectively, which is statistically significant. The frequency of hypocalcemiawas 40% in neonates with unconjugated hyperbilirubinemia after 24 hours of phototherapy.Conclusion: Hypocalcemia is an important complication in neonates with unconjugated hyperbilirubinemia after continuousphototherapy. Hypocalcemia has clinical impact and adds to morbidity, and if left untreated, can lead to mortality.

Download Full-text

Correlation between Serum Calcium and Phosphate with Coronary Artery Calcium Scores on Cardiac MSCT Examination

Saintika Medika ◽

10.22219/sm.vol15.smumm2.9970 ◽

2019 ◽

Vol 15 (2) ◽

pp. 120

Author(s):

Rosita Kai ◽

Bachtiar Murtala ◽

Andi Alfian Zainuddin ◽

Muzakkir Amin ◽

Muhammad Ilyas

Keyword(s):

Coronary Artery ◽

Kidney Function ◽

Serum Calcium ◽

Coronary Artery Calcium ◽

Cross Sectional Study ◽

Serum Phosphate ◽

Normal Kidney ◽

Cross Sectional ◽

Normal Kidney Function ◽

The Relationship

Increased serum calcium and phosphate associated with cardiovascular disease in patients with chronic kidney disease, but research on the relationship between coronary artery calcium scores with serum calcium and phosphate in individuals with normal kidney function is lacking. We explore the relationship of serum calcium and phosphate levels with coronary atherosclerosis as assessed by cardiac Multislice Computed Tomography (MSCT) in individuals with normal kidney function. This study aims to assess the correlation of calcium level scores on cardiac MSCT examination with serum calcium and phosphate levels, and assess the association with risk factors for coronary heart disease. This study was a cross-sectional study of 40 subjects who underwent cardiac MSCT examination with normal kidney function, at RSUP Dr. Wahidin Sudirohusodo Makassar during the March-July 2019 period. The results showed an correlation between coronary artery calcium scores with calcium and serum phosphate (serum calcium r = 0.67, serum phosphate r = 0.53, p <0.05).

Download Full-text

Association between Serum Calcium and First Incident Acute Myocardial Infarction: A Cross-Sectional Study

Iranian Journal of Public Health ◽

10.18502/ijph.v49i7.3581 ◽

2020 ◽

Author(s):

Chi ZHANG ◽

Bangming CAO ◽

Xingmei HUANG ◽

Jian GU ◽

Ming XIA ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Logistic Regression ◽

Serum Calcium ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Gender And Age ◽

Artery Disease

Background: The role of serum calcium in coronary artery disease (CAD) patients with or without first incident acute myocardial infarction has not been studied previously. This study aimed to assess the relationship between serum calcium and first incident acute myocardial infarction. Methods: This cross-sectional study was conducted from Jan 2014 to Dec 2016. All the participants were from our database, described in detail elsewhere including 1609 cases and 3252 controls. Multiple logistic regression was carried out to explore the effect of serum calcium on first incident acute myocardial infarction. Interaction between serum calcium and risk factors were evaluated. Results: Patients with first incident acute myocardial infarction have significantly lower serum calcium concentrations than those without acute myocardial infarction (2.18 (0.21) vs 2.24 (0.19) mmol/L, P<0.0001). After adjusting for sex and age, logistic regression showed that serum calcium was significantly associated with first incident acute myocardial infarction (odds ratio (OR): 1.50, 95% confidence interval (CI): 1.41-1.60). Further adjusted for potential confounders, serum calcium was associated with first incident acute myocardial infarction (OR: 1.32, 95% CI: 1.22-1.42). Moreover, the association still existed when patients were divided into subgroups according to gender and age. A significant interaction was found between serum calcium and diabetes mellitus (DM), lipoprotein (a) (Lp (a)), and serum albumin. Conclusion: Serum calcium was associated with first incident acute myocardial infarction among CAD patients in both sexes and in age categories. This study provides further evidence showing the value of serum calcium levels in clinical practice.

Download Full-text

Differences in Surgical Outcome in Near Total Thyroidectomy for Benign Nodular Goiter: A Comparison of LigaSure Vessel Sealer versus Conventional Clamp Knot Tie Technique

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i30b31641 ◽

2021 ◽

pp. 65-69

Author(s):

Shiraz Shaikh ◽

Champa Sushel ◽

Ahsan Ali Laghari ◽

Qamber Ali Laghari ◽

Zameer Hussain Laghari ◽

...

Keyword(s):

Hospital Stay ◽

Total Thyroidectomy ◽

Calcium Level ◽

Operative Time ◽

Nodular Goiter ◽

Cross Sectional Study ◽

Cross Sectional ◽

Post Operative Pain ◽

Significant Difference ◽

One Year

Objective: To compare the efficacy of LigaSure Vessel Sealer in Near Total Thyroidectomy versus Conventional Clamp Knot Tie Technique in terms of bleeding, operative time and postoperative drainage. Methodology: This comparative cross sectional study was conducted at Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro. Study duration was one year from November 2019 to October 2020. All patients of any age with benign multinodular goiter and either of gender were included. The study subjects were grouped into two categories by randomization (odd / even). The odd numbers were given to patients operated for ligasure and even numbers were given to patients operated with conventional clamp knot tie technique. Outcomes were observed with respect to post-operative calcium level, intra-operative bleeding, operative time, post-operative pain & post-operative hospital stay. All the data was recorded via study proforma. Data was analyzed by using SPSS version 20. Results: Total 55 patients were observed. Mean age was 33.25±10.60 years in clamp knot tie procedure group and 35.16±07.96 years in ligasure technique group; without significant difference (p-0.448). Pre and post-operative calcium levels were statistically insignificant among both groups (p-0.358 and 0.163), while loss of blood, hospital stay, post-operative pain and operative duration were significantly greater in clamp knot tie technique group in comparison to ligasure technique group (p-<0.001). Conclusion: LigaSure Vessel Sealer is a feasible and reliable surgical technique and significantly more effective as compared to conventional clamp knot tie technique in terms of post-operative bleeding, operative time, post-operative pain and post-operative hospital stay. However, calcium level was statistically insignificant.

Download Full-text

Prevalence of Gaucher Disease (GD) in Patients with Unknown Cause of Splenomegaly and/or Thrombocytopenia in Saudi Arabia: A Multicenter Cross-sectional Study Protocol (Preprint)

10.2196/preprints.28607 ◽

2021 ◽

Author(s):

Abdulelah Qadi ◽

Aly Ezzat ◽

Ayman Al Hejazi ◽

Fahad Al Abbas ◽

Ghaleb Elyamany ◽

...

Keyword(s):

Saudi Arabia ◽

Gaucher Disease ◽

Cross Sectional Study ◽

Primary Objective ◽

High Risk Group ◽

Acid Sphingomyelinase ◽

Lysosomal Storage ◽

Sectional Study ◽

Eligibility Criteria ◽

Cross Sectional

UNSTRUCTURED Background: Gaucher disease (GD) is the commonest form of Lysosomal storage disorders that are characterized by the accumulation of glucosylceramide within the lysosomes of cells that are ordinarily degraded to glucose and lipid components. The primary objective of this study is to determine the prevalence of Gaucher Disease in a high-risk group (defined as patients with splenomegaly and/or thrombocytopenia of unknown cause). Methods: The present multicenter, cross-sectional, study will include patients presenting with signs of splenomegaly and/or thrombocytopenia over a period of 12 months with no definitive cause. Eligible patients will be assessed for acid β-glucosidase and acid sphingomyelinase enzymes activity using dried blood spot (DBS) samples. A total of 400 patients from Saudi Arabia who fulfill the eligibility criteria will be enrolled in the study. Discussion: Saudi Arabia is the largest country in the Arabian Peninsula, with a population of more than 28 million. Despite healthcare being free to Saudi citizens, a number of potential barriers to healthcare access and individual healthcare-seeking have been reported. While Gaucher disease is a rare disease, its incidence in Saudi Arabia appears to be higher than other parts of the world. Nevertheless, no previous nationwide study was conducted to provide reliable data regarding the incidence and characteristics of Saudi patients with Gaucher Disease. There is a scarcity in the published literature regarding the treatment patterns and outcomes of Gaucher Disease in Saudi Arabia as well.

Download Full-text