Early and Late Hypocalcaemia After Total Thyroidectomy Prospective Study

Background Hypocalcaemia post total thyroidectomy, is one of the most common complication observed in patients who undergo bilateral thyroid resection. Although hypocalcaemia is self-limiting in most patients and does not require treatment, symptomatic hypocalcaemia is of particular concern. We aimed to evaluate the incidence of hypocalcaemia post total thyroidectomy with evaluation of serum calcium levels as a cheap and available method so we can identify patients at risk of postoperative hypocalcaemia who require supplementation treatment, and those not at risk who can be safely discharged without any supplementation treatment. Objective To assess the incidence of postoperative hypocalcaemia post total thyroidectomy wither it’s temporary or permanent. Methods prospective analysis of 100 patients undergoing total thyroidectomy. Preservation of parathyroid glands and their blood supply was attempted in all cases. The patients were assessed for manifestations of hypocalcaemia after thyroidectomy. The assessment was done through: (1) monitoring the total and ionized calcium level 24 hours postoperatively, (2) Total and ionized calcium level was measured in the third week postoperative, (3) clinical examination and detection of symptoms and signs of hypocalcaemia, (4) In resistant cases assessment of total and ionized calcium and PTH at 3 and 6 months. Results The study included 87 females and 13 males, 37 was the mean age; 15 patients developed symptoms of hypocalcaemia (15%), 8 of them were asymptomatic but 7 of them developed symptoms, 85 patients did not develop any clinically manifested symptoms of hypocalcaemia (85%). all of them recovered from hypocalcaemia except 2 patients, one of them recovered at 3 months postoperative and the other one didn’t recover from hypocalcaemia so we diagnose it’s case as a permanent hypocalcaemia post total thyroidectomy. Conclusion Results of this study indicate that measuring calcium postoperative is a cheap and available lab investigation to indicate hypocalcaemia post total thyroidectomy, and as we mentioned before that we don’t need to prescribe calcium or vitamin D to all the patients underwent total thyroidectomy as an empirical treatment to prevent hypocalcaemia but we prescribe it just to patients developed symptoms of hypocalcaemia as it will be costly to the patient.

Post-operative hypocalcemia in patients undergoing thyroid surgeries in tertiary care hospital: an observational study

<p><strong>Background: </strong>Post-operative hypocalcaemia is one of the most common complications of thyroid and parathyroid surgery. Temporary hypocalcaemia has been reported to occur in 1.6-50% of the patients undergoing bilateral thyroid resection. Permanent hypoparathyroidism results in 0-13% of patients after bilateral thyroid surgery.</p><p><strong>Method: </strong>We have analyzed the data of 34 patients undergoing total thyroid surgery (with or without neck dissection) and completion thyroidectomy at the department of ENT and HNS, SMHS hospital over a period of 1.5 years between May 2019 to November 2020.</p><p><strong>Results:</strong> Hypocalcemia was found in a total of 15 patients out of 34 patients in the post-op period. Among the total patients who developed hypocalcemia 5 (14.7%) were males and 10 (29.4%) were females. Among the patients who developed post-op hypocalcemia 14 patients developed transient hypocalcemia (p&gt;0.01) which is not statistically significant and 1 patient developed permanent hypocalcemia (p&gt;0.01) which also has no statistical significance.</p><p><strong>Conclusions: </strong>The study suggests that female gender is a strong risk factor for developing post-operative hypocalcemia, other factors that play a role include difference in serum calcium levels in the perioperative period and type of surgery.</p>

A MATHEMATICAL MODEL FOR TREATMENT OF PAPILLARY THYROID CANCER USING THE ALLEE EFFECT

The incidence of thyroid cancer is rising all over the world, and the papillary subtype (PTC) is the primary factor for this increase. The presence of thyroid tumors is commonly associated with increased levels of cytokines, such as interleukin 6 (IL-6). Considering PTC patients treated with thyroidectomy and radioactive iodine [Formula: see text]I (RAI), we propose an ordinary differential system using four variables: the RAI activity, the number of cancer cells and the serum concentrations of IL-6 and thyroglobulin (Tg). Our objective is to study the efficacy of different therapeutic doses of RAI in the treatment of thyroid cancer. The Allee effect is taken into account when modeling cancer cells growth under the influence of IL-6. From the results obtained, the main factors and conditions correlated with successful treatment, such as the RAI activity used and the tumor response are addressed. The detection of minimal doses of RAI that can cause tumor extinction is performed, though this has also meant longer periods for tumor cell elimination. The critical number of tumor cells due to the Allee effect is analyzed and linked to the immune system or biological factors that can slow the progression of the tumor but are insufficient after thyroid resection surgery.

Hypothyroidism in surgically treated T4 hypopharyngeal and laryngeal cancers

<p class="abstract"><strong>Background:</strong> Total laryngectomy in laryngohypopharyngeal cancers, both in primary setting and salvage scenario, include variable amounts of thyroid resection. Although considerable proportion of these cases undergo total thyroidectomy, with an intention of wider surgical clearance, histopathological examination for thyroid infiltration, very often indicate that such resections are generally out of proportion to the actual oncological requirement.</p><p class="abstract"><strong>Methods:</strong> Forty three patients undergoing total laryngectomy with no prior thyroid dysfunction, from April 2014 to 2016, at our centre, were prospectively studied for post treatment, thyroid function with tests done at 6^th month. Overt and occult hypothyroidism was correlated with extent of thyroid preserved intraoperatively. </p><p class="abstract"><strong>Results:</strong> Of 43 patients studied, 82% had extralaryngeal spread, and 16% of them showed thyroid gland infiltration. Only 7% were patholog1ically correlated for gland infiltration. Among those who had hemithyroidectomy, clinical hypothyroidism was seen in 20% primary and 85% salvage cases by 6^th month of post treatment period.</p><p><strong>Conclusions:</strong> In clinicoradiologically favourable scenarios, thyroid preservation attempt helps to augment the neopharynx closure line and to preserve the parathyroids. Anatomical preservation however doesnot guarantee thyroid function, which needs regular follow up to avoid post-operative complications and better QOL.</p>