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.

Incidence of postoperative hypocalcaemia in patients with preoperative cytological evidence of Hashimoto’s thyroiditis undergoing thyroidectomy

Background: Hashimoto’s thyroiditis is an autoimmune pathology presents as a painless goiterogenous condition. It manifests as hypothyroidism, occurring in females of the age group 30-40. Patients are operated for cosmetic symptoms or suspicions of malignancy. The surrounding adhesions and fibrosis of the gland makes it more prone for hypocalcaemia post operatively. This study was conducted to find the incidence of hypocalcaemia postoperatively in patients with Hashimoto’s thyroiditis.Methods: Patients above 13 years undergoing total thyroidectomy where completion thyroidectomy after hemi thyroidectomy, concurrent lymph node dissection, patients on calcium therapy or the ones with preexisting hypocalcaemia were excluded from the study. 100 patients were studied from 1 January 2018 to 1 January 2019 and corrected serum calcium levels at 24 hours, 48 hours and 2 weeks estimated postoperatively. Analysis was done using CSC sepi-info software. Qualitative data were analyzed with Chi square, Z test and ANOVA test.Results: Though 32/100 patients had hypocalcemic symptoms only 26 (26%) had low calcium biochemically. The association between Hashimoto’s thyroiditis and post thyroidectomy hypocalcaemia had significant association (p<0.0001). 11.53% (3/26) had recovered in 48 hours and at two weeks 10 patients remained hypocalcemic with a recovery of 61.53%.Conclusions: Hypocalcaemia after total thyroidectomy in Hashimoto’s thyroiditis occurs due to fibrosis in gland, adhesions to the adjacent structures, injury to the parathyroid glands during surgery and non-identification of parathyroid glands.

Risk factors for postoperative hypocalcaemia after thyroidectomy: A systematic review and meta-analysis

Objective A meta-analysis to investigate the risk factors for postoperative hypocalcaemia after thyroidectomy in adult patients. Methods A systematic search of publications in the electronic databases (PubMed®, The Cochrane Library, Web of Science, OVID and Embase®) from inception to June 2020 was conducted. Screening of titles, abstracts and full texts and data extraction were independently performed by two authors. The OR was selected as the pooled estimate. Results The analysis included 23 studies. Twelve significant risk factors for postoperative hypocalcaemia were identified: hypoparathyroidism, OR 5.58; total thyroidectomy, OR 3.59; hypomagnesaemia, OR 2.85; preoperative vitamin D deficiency, OR 2.32; female sex, OR 1.49; thyroid malignancy, OR 1.85; thyroiditis, OR 1.48; substernal multinodular goitres, OR 1.70; parathyroidectomy, OR 1.58; central compartment neck dissection, OR 1.17; modified radical neck dissection, OR 1.57; and central neck dissection, OR 1.54. Conclusions This meta-analysis provides moderate-to-high quality evidence that the 12 risk factors were predictive of postoperative hypocalcaemia, which should be monitored closely before thyroidectomy.

Electrosurgical energy. Is it a risk factor for post-thyroidectomy hypocalcaemia?

Aim and objective: The aim of this study was to investigate a relationship between the different types of electrosurgical energy (monopolar, bipolar, and ultrasonic-harmonic scalpel) and postoperative hypocalcaemia after total thyroidectomy. Additionally, to analyze the frequency of postoperative hypocalcaemia, according to age group, gender, and pathological diagnosis. Materials and Methods: An observational, retrospective and correlational study was carried out in a series of patients who underwent total thyroidectomy in a public and a private hospital in Quito, Ecuador, South America, from January 2016 to July 2019. Results: Among 665 patients, post-thyroidectomy hypocalcaemia was observed in 127 (18.8%) patients. There was no significant difference between males and females. Hypocalcaemia was significantly higher in patients aged between 26 and 35 years, patients operated for malignant tumors and in patients in whom at least one parathyroid gland was removed. Postoperative hypocalcaemia occurred in 52.2% of patients (n = 24) [RR: 3.14; 95% CI: 2.26-4.36; p: 0.001] in the bipolar group, 29.2% (n = 7) [RR: 1.56; 95% CI: 0.82-2.97; p: 0.087] in the harmonic group, 17.3% (n = 34) [RR: 0.87; 95% CI: 0.61-1.24; p: 0.219] in the monopolar group, and 15.2% (n= 60) [RR: 0.61; 95% CI 0.45-0.84; p: 0.001] in the monopolar + harmonic group. Conclusions and clinical significance: The use of a bipolar device appears to be a risk factor for hypocalcaemia, while the use of monopolar + harmonic seems to be a protective factor. Although, when analyzing monopolar + harmonic vs monopolar alone, the addition of the harmonic scalpel didn’t provide statistically significant additional protection against hypocalcaemia.

Assessment of Effect of Preoperative Vitamin D Deficiency on Postoperative Hypocalcemia after Total Thyroidectomy, A Prospective Study

Background One-day surgeries are routinely performed for hemithyroidectomy, but hospital stay duration is more controversial after total thyroidectomy due to postoperative, potentially life-threatening complications. Aim of the Work The aim of this study is to assess the effect of pre-operative vitamin D3 deficiency on post thyroidectomy hypocalcemia. Patients and Methods Type of Study: This was a prospective cohort study which included 60 Egyptian patients for whom total thyroidectomy had been performed. Study Setting: Patients were recruited from general surgery department at Kafr Elshiekh University Hospital and Ain Shams University Hospital. Study Period: The study duration was form April 2018 to October 2018. Results The main findings of the current study as regards to calcium was that the mean preoperative level of calcium was 9.61 ± 0.48 mg/dl, the lowest level of postoperative calcium was detected after 48 hours (9.03 ± 0.73) and the highest postoperative level was measured 12 hours after the operation. With respect to relation between calcium and preoperative vitamin D, the results showed that no patients with normal preoperative vitamin D had a postoperative hypocalcaemia 12, 24, 48 or 72 hours after the operation. After one month, however, 2 patients with normal preoperative vitamin D level, had hypocalcaemia. It worth mention that these two patients had border line normal preoperative vitamin D level. The percentage of patients with low preoperative vitamin D level who had postoperative hypocalcaemia was 5%, 5%, 25% and 15% after the operation by 12, 24, 48 and 72 hours respectively while after one month, the percentage was 10%. The differences between hypocalcaemia incidence between patients with normal and below normal vitamin D levels was statistically significant although it was a borderline significance. The sensitivity and specificity of preoperative vitamin D level in prediction of postoperative hypocalcaemia was 87.50% and 40.91% respectively. Conclusion After investigating the postoperative calcium level in patients with and without preoperative vitamin D deficiency, the study had the following conclusions: Vitamin D deficiency is significantly common among Egyptian population, postoperative hypocalcaemia is closely related to the preoperative vitamin D level and patients with hypovitaminosis D are more labile to hypocalcaemia and females are more likely to have postoperative hypocalcemia.

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

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.