DOI: http://dx.doi.org/10.18203/2349-2902.isj20214072

Incidence of hypocalcaemia among post-thyroidectomy patients at a tertiary care hospital at Trivandrum, Kerala, South India

Deepu Thottath, Dayananda Babu, Saravanan Thangavel, Radhika Kannan

Abstract


Background: Hypocalcemia is one of the most common complications of thyroid surgery. It is usually temporary, but it may rarely take several months to resolve. The aim of this study was to determine the incidence of hypocalcaemia after total thyroidectomy and assess the biochemical factors that may be predictive of hypocalcemia.

Methods: An observational study was conducted in 98 patients at the general surgery department of a tertiary care medical college hospital for a period of one year. Convenient method of sampling was done. All the patients undergoing total thyroidectomy were included in this study. The serum calcium level was evaluated at different times in the post-operative period as a part of the routine post-operative care at the hospital. During the postoperative period patients were carefully watched for clinical symptoms and signs of hypocalcemia.

Results: In the study group, 19 (19.4%) had hypocalcemia. In the study group, 14 (14.3%) had symptomatic hypocalcemia and 5 patients (5.1%) had asymptomatic hypocalcemia. 18 patients (18.4%) had temporary hypocalcemia and 1 patient (1%) had permanent hypocalcemia. Among the patients with hypocalcemia, 18 (95%) were females and 1 (5%) patient was male. 13 (68%) patients were euthyroid, 5 (26%) patients were hyperthyroid and 1 (5%) patient was hypothyroid. Significant association was seen between diagnosis of thyroid disorders and hypocalcemia, thyroid function and hypocalcemia and between operating time and hypocalcemia.

Conclusions: Incidence of hypocalcemia in patients who had undergone total thyroidectomy was found to be less. Majority of them had temporary hypocalcemia and permanent hypocalcemia was seen only in one patient.


Keywords


Hypocalcemia, Post-thyroidectomy, Thyroid surgery

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References


Smith P, Salomone L, Hanks JB. Sabiston Text Book of Surgery Volume 1. 19th edition. Townsend C, editor. Philadelphia: Saunders Elsevier. 2012;38:886-921.

Pfleiderer AG, Ahmad N, Drapers MR, Vrotsou K, Smith WK. The timing of calcium measurements in helping to predict temporary and permanent hypocalcaemia in patients having completion and total thyroidectomies. Ann R Coll Surg Engl. 2009;91:140-6.

Nair CG, Babu MJC, Menon R, Jacob P. Hypocalcaemia following total thyroidectomy: An analysis of 806 patients. Indian J Endocrinol Metab. 2013;17:298-303.

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

Sturniolo G, Lo Schiavo MG, Tonante A, D’Alia C, Bonanno L. Hypocalcemia and hypoparathyroidism after total thyroidectomy: a clinical biological study and surgical considerations. Int J Surg Investig. 2000;2:99-105.

Jacobs JK, Aland JW, Ballinger JF. Total thyroidectomy. A review of 213 patients. Ann Surg. 1983;197:542-9.

Lo CY, Lam KY, Weber CJ, Shaha AR, Davis O. Postoperative hypocalcemia in patients who did or did not undergo parathyroid autotransplantation during thyroidectomy: A comparative study. Surgery. 1998;124:1081-7.

Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, et al. Hypocalcemia following thyroid surgery: Incidence and prediction of outcome. World J Surg. 1998;718-24.

Stathatos N. Thyroid Physiology. Med Clin North Am. 2012;165-73.

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

Pisanu A, Cois A, Piu S, Altana ML, Uccheddu A. Factors predicting outcome of hypocalcaemia following total thyroidectomy. Chir Ital. 2003;55:35-40.

Ahmed MAS, Martinez A, Mariam S, Whitehouse W. Chvostek’s sign and hypocalcaemia in children with seizures. Seizure. 2004;13:217-22.

Jesus JE, Landry A. Chvostek’s and Trousseau's Signs. N Engl J Med. 2012;15.

Hoffman E. The Chvostek sign A clinical sign. Am J Surg. 1958;96:33-7.

Huang SM. Do we overtreat post-thyroidectomy hypocalcemia? World J Surg. 2012;36:1503-8.

Herranz González-Botas J, Lourido Piedrahita D. Hypocalcaemia after total thyroidectomy: incidence, control and treatment. Acta otorrinolaringológica española. 2013;64:102-7.

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;133:180-5.

Riju R, Jadhav S, Kanthaswamy R, Jacob P, Nair CG. Is total thyroidectomy justified in multinodular goitre. J Indian Med Assoc. 2009;107:223-5.

Puzziello A, Rosato L, Innaro N, Orlando G, Avenia N, Perigli G, et al. Hypocalcemia following thyroid surgery: incidence and risk factors. A longitudinal multicenter study comprising 2,631 patients. Endocrine. 2014.

Page C, Strunski V. Parathyroid risk in total thyroidectomy for bilateral, benign, multinodular goitre: report of 351 surgical cases. J Laryngol Otol. 2007;121:237-41.

Wingert DJ, Friesen SR, Iliopoulos JI, Pierce GE, Thomas JH, Hermreck AS. Post-thyroidectomy hypocalcemia. Incidence and risk factors. Am J Surg. 1986;152:606-10.

Moure Rodríguez MD, Luque-Ramírez M, López Gallardo G, López Iglesias M, Gómez-Pan A. Hungry bone syndrome related to hyperthyroidism. Anales de medicina interna (Madrid, Spain : 1984). 2006;326-8.