Hypocalcemia After Thyroid Surgery Single-Center Experience Based on 987 Patients Operated on for Various Thyroid Diseases Within One Year
Languages of publication
The aim of the study was to compare the extent of surgery in removal of thyroid tissue and serum calcium values postoperatively.Material and methods. Between January 1 and December 31, 2005, 987 patients were operated on at our department due to various thyroid disorders. Patients with anaplastic, medullary and high-stage highly-differentiated (TNM>T3, N0, M0) thyroid carcinomas, as well as reoperated individuals, were excluded from the investigation. The patients were divided into three groups, depending on their serum calcium values; thus, the authors distinguished groups with mild (2.0-2.19 mmol/l), moderate (1.8-1.99 mmol/l) and severe hypocalcemia (<1.8 mmol/l). Differences between the groups were assessed by statistical methods (the t-Student's test and the X2 test - the STATISTICA software). The value of p<0.05 was accepted as statistically significant.Results. Of 987 surgical patients, 63 (6.4%) were found to have symptomatic or asymptomatic hypocalcemia. The group included 61 females and two males, their mean age being 50.1±12 years. The intensity of clinical symptoms of hypoparathyroidism was positively correlated with serum calcium values and the said symptoms were most clearly seen in patients classified as belonging to group 3 (Ca<1.8 mmol/l). The most common surgically treated thyroid disease was non-toxic nodular goiter. Hypocalcemia was the most frequent finding in patients operated on due to thyroid carcinoma. In all patients with a mild form of hypocalcemia, the onset of clinical symptoms occurred on postoperative day 2. As it follows from the analysis, there were no statistically significant differences in hypocalcemia prevalence between patients subjected to bilateral exposure of the thyroid lobes and subtotal vs. total thyroidectomy (6 (6.1%) vs 24 (7.1%) patients). On the other hand, a statistically significant difference between the lower prevalence rate of hypocalcemia in unilateral procedures (p<0.001) as compared to bilateral neck explorations (4 (1.4%) vs 59 (8.4%) patients) seems to be logical and physiologically justified. In addition, an element that was found to affect the level of calcium deficit was the number of parathyroid glands identified "in situ". Hence, the prevalence of hypocalcemia increased with a decrease in the number of identified parathyroids (p<0.05). In hypocalcemic patients, hospitalization time ranged from 3 to 11 days, with a mean time of 5.3 days as compared to 3 days in patients without complications. Six months after the surgery and pharmacotherapy, no clinical and biochemical signs of hypocalcemia were noted in the above described group.Conclusions. The risk of hypocalcemia following thyroid surgery is higher in bilateral neck explorations. There are no statistically significant differences in postoperative hypocalcemia between patients subjected to bilateral subtotal vs. total thyroidectomies.
1 - 7 - 2007
27 - 11 - 2007
- Di Fabio F, Casella C, Bugari G et al.: Identification of patients at low risk for thyroidectomy-related hypocalcemia by intraoperative quick PTH. World J Surg 2006; 30: 1428-33.
- Quiros RM, Pesce CE, Wilhelm SM et al.: Intra-operative parathyroid hormone levels in thyroid surgery are predictive of postoperative hypoparathyroidism and need for vitamin D supplementation. Am J Surg 2005; 189: 306-09.
- Bellantone R, Lombardi CP, Bossola M et al.: Total thyroidectomy for management of benign thyroid disease: review of 526 cases. World J Surg 2002; 26: 1468-1471.
- Lo CY, Luk JM, Tam SC: Applicability of intra-operative parathyroid hormone assay during thyroidectomy. Ann Surg 2002; 236: 564-69.
- Uruno T, Miyauchi A, Shimizu K et al.: A prophylactic infusion of calcium solution reduces the risk of symptomatic hypocalcemia in patients after total thyroidectomy. World J Surg 2006; 30: 304-08.
- Dotzenrath CME, Cupisti K, Raffel A et al.: Do Germans keep patients too long in hospital? A prospective randomized trial. World J Surg 2005; 29: 1189-93.
- Barczyński M, Cichoń S, Anielski R, Pasierb S: Częstość występowania niedoczynności przytarczyc po operacji wola - profilaktyka i leczenie. Pol Przegl Chir 1996; 68: 133-38.
- Harness JK, Fung L, Thompson N et al.: Total tyroidectomy: complications and technique. World J Surg 1996; 10: 781-86.
- Jacobs JK, Aland JW, Ballinger JF: Total thyroidectomy. Ann Surg 1983; 197: 542-48.
- Delbridge L, Guinea A, Reeve TS: Total thyroidectomy for bilateral benign multinodular goiter. Arch Surg 1999; 134: 1389-93.
- Reeve TS, Delbridge L, Cohen A et al.: Total thyroidectomy. The preferred option for multinodular goiter. Ann Surg 1987; 206: 782-86.
- Pappalardo G, Guadalaxara A, Frattaroli F et al.: Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Eur J Surg 1998; 164: 501-06.
- Alimoglu O, Akdag M, Sahin M et al.: Comparison of surgical techniques for treatment of benign toxic multinodular goiter. World J Surg 2005; 29: 921-24.
Publication order reference