Published: 2020-03-26

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

Mohamed O. Benkhadoura, Abdulwahab M. Elbarsha, Khaled K. Elgazwi, Akrem I. Elshaikhy, Talal K. Elkhweldi, Othman H. Tajoury, Jamal A. Alsharif, Abdulgadir M. Abdulrahman


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.


Hypocalcemia, Serum calcium, Thyroidectomy

Full Text:



Aggeli C, Zografos GN, Katseli A, Tsipras I. Τhyroid surgery and postoperative hospital stay. Hellenic J Surg. 2015;87:111-4.

Rosa KM, Matos LL, Cernea CR, Brandao LG, Filho VJF. Postoperative calcium levels as a diagnostic measure for hypoparathyroidism after total thyroidectomy. Arch Endocrinol Metab. 2015;59(5):428-32.

Pasquale DL, Sartori PV, Vicentini L, Beretta E, Boniardi M, Leopaldi E, et al. Necessity of therapy for post-thyroidectomy hypocalcaemia: a multi-centre experience. Langenbecks Arch Surg. 2015;400:319-24.

Asari R, Passler C, Kaczirek K, Scheuba C, Niederle B. Hypoparathyroidism after total thyroidectomy: a prospective study. Arch Surg. 2008;143:132-7.

Lazard DS, Godiris PG, Wagner I. Early detection of hypocalcemia after total or completion thyroidectomy: routinely usable algorithm based on serum calcium level. World J Surg. 2012;36:2590-7.

Raffaelli M, Crea DC, Carrozza C. Combining early postoperative parathyroid hormone and serum calcium levels allows for an efficacious selective post-thyroidectomy supplementation treatment. World J Surg. 2012;36:1307-13.

Cayo AK, Yen TW, Misustin SM. Predicting the need for calcium and calcitriol supplementation after total thyroidectomy: results of a prospective, randomized study. Surgery. 2012;152:1059-67.

Salinger EM, Moore JT. Perioperative indicators of hypocalcemia in total thyroidectomy: the role of vitamin D and parathyroid hormone. Am J Surg. 2013;206(6):876-81.

Tredici P, Grosso E, Gibelli B, Massaro MA, Arrigoni C, Tradati N. Identification of patients at high risk for hypocalcemia after total thyroidectomy. Acta Otorhinolaryngol Ital. 2011;31:144.

Delbridge L. Selective rather than routine: using sound clinical judgment. Arch Surg. 2012;147:344.

Kolly A, Sarathi V, Bothra S, Chekavar A, Sabaretnam M, Agarwal A. Hypocalcemia: what a surgeon should know. WJOES. 2017;9(2):72-7.

Sperlongano P, Sperlongano S, Foroni F, Lucia FP, Pezzulo C, Manfredi C, et al. Postoperative hypocalcemia: assessment timing. Int J Surg. 2014;12:95-7.

Pasquale S, Rossella S, Adriano M, Salvatore M, Emanuela E, Alessandro E, et al. Post-thyroidectomy hypocalcemia: timing of discharge based on serum calcium levels. Surg Res Open J. 2015;2(2):62-5.