DOI: http://dx.doi.org/10.18203/2349-2902.isj20204990

Serum calcium slope is a predictor of post-thyroidectomy hypocalcemia

Veena Vasudev, Anil Kumar A. V.

Abstract


Background: Hypocalcemia is a common complication following thyroidectomy. The effects of hypocalcemia can range from simple numbness to life-threatening seizures. Barring stridor, haemorrhage and hypocalcemia, other complications of thyroidectomy are not seriously morbid and hence patients can be sent home. This study sought to determine whether early postoperative calcium levels can predict hypocalcemia following thyroidectomy, to help decide on early discharge.

Methods: This was a prospective cohort study, conducted between July 2016 and June 2017 among 80 consecutive patients who underwent total thyroidectomy in our department. Serum calcium values were obtained pre-operatively and at 6 and 24 hours post-operatively. Serum calcium slopes were calculated and the receiver operating characteristic curve constructed to evaluate the accuracy of risk prediction.

Results: The mean total calcium levels of patients with hypocalcemia were significantly lower than the levels of the normocalcemic group. The slope of change between total calcium measurements at 6 and 24 hours in patients with hypocalcemia was found to be significantly steeper than the slope in the case of normocalcemic patients.

Conclusions: It is possible to predict post-thyroidectomy hypocalcemia based on the characteristics of the early post-operative serum calcium slope. On the basis of the slope’s features, all patients except those at risk can be safely discharged home early. This can cut down on the patients’ total cost of treatment as well as save unnecessary wastage of health resources.


Keywords


Hypocalcemia, Parathyroid, Serum calcium, Thyroidectomy

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References


Halsted WS. The operative story of goitre. Johns Hopkins Hosp Rep. 1920;19:71.

Thompson NW. The history of hyperparathyroidism. Acta Chir Scand. 1990;156:5-21.

Kocher T. Uber Kropfextirpation und ihre Folgen. Arch Klin Chirurgie. 1883;29:254.

Mowschenson PM, Hodin RA. Outpatient thyroid and parathyroid surgery: a prospective study of feasibility, safety, and costs. Surgery. 1995;118:1051-4.

Marohn MR, LaCivita KA. Evaluation of total/near-total thyroidectomy in a short-stay hospitalization: safe and cost-effective. Surgery. 1995;118(6):943e7.

Bhattacharyya N, Fried MP. Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surg. 2002;128(4):389e92.

Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery. 2003;133(2):180e5.

Wingert DJ, Friesen SR, Iliopoulos JI, Pierce GE, Thomas JH, Hermreck AS. Post-thyroidectomy hypocalcemia. Incidence and risk factors. Am J Surg. 1986;152(6):606e10.

Bourrel C, Uzzan B, Tison P, Despreaux G, Frachet B, Modigliani E, et al. Transient hypocalcemia after thyroidectomy. Ann Otol Rhinol Laryngol. 1993;102(7):496-501.

Chisthi MM, Nair RS, Kuttanchettiyar KG, Yadev I. Mechanisms behind Post-Thyroidectomy Hypocalcemia: Interplay of Calcitonin, Parathormone, and Albumin-A Prospective Study. J Invest Surg. 2017;30(4):217-25.

Demeester-Mirkine N, Hooghe L, Van Geertruyden J, De Maertelaer V. Hypocalcemia after thyroidectomy. Arch Surg. 1992;127(7):854-58.

McHenry CR, Speroff T, Wentworth D, Murphy T. Risk factors for post thyroidectomy hypocalcemia. Surgery. 1994;116(4):641-8.

Testini M, Nacchiero M, Miniello S, Piccinni G, Di Venere B, Lissidini G, et al. One-day vs standard thyroidectomy. A perspective study of feasibility. Minerva Endocrinol. 2002;27(3):225e9.

Hans SS, Lee PT. Post-thyroidectomy hypoparathyroidism. Am Surg. 1976;42(12):930-3.

Adams J, Andersen P, Everts E, Cohen J. Early postoperative calcium levels as predictors of hypocalcemia. Laryngoscope. 1998;108(12):1829-31.

Walsh SR, Kumar B, Coveney EC. Serum calcium slope predicts hypocalcaemia following thyroid surgery. Int J Surg. 2007;5:41-4.

Erbil Y, Barbaros U, Temel B, Turkoglu U, İşsever H, Bozbora A, et al. The impact of age, vitamin D3 level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy. Am J Surg. 2009;197(4):439-46.

Moore FD Jr. Oral calcium supplements to enhance early hospital discharge after bilateral surgical treatment of the thyroid gland or exploration of the parathyroid glands. J Am Coll Surg. 1994;178(1):11-6.

Pallotti F, Seregni E, Ferrari L, Martinetti A, Biancolini D, Bombardieri E. Diagnostic and therapeutic aspects of iatrogenic hypoparathyroidism. Tumori. 2002;89(5):547-9.

Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. W J Surg. 2000;24(11):1335-41.

Noureldine SI, Genther DJ, Lopez M, Agrawal N, Tufano RP. Early predictors of hypocalcemia after total thyroidectomy: an analysis of 304 patients using a short-stay monitoring protocol. JAMA Otolaryngol Head Neck Surg. 2014;140(11):1006-13.

Abboud B, Sargi Z, Akkam M, Sleilaty F. Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg. 2002;195(4):456-61.

Nemade SV, Chirmade AP. Post-thyroidectomy early serum ionic calcium level: predictor of prolonged hypocalcemia. Ear Nose Throat J. 2013;92(8):382-90.

Leahu A, Carroni V, Biliotti G. Calcium level, a predictive factor of hypocalcemia following total thyroidectomy. J de Chirurgie. 2009;5:148-52.

Husein M, Hier MP, Al-Abdulhadi K, Black M. Predicting calcium status post thyroidectomy with early calcium levels. Otolaryngol Head Neck Surg. 2002;127(4):289-93.