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Clinical and Metabolic Changes Following Complicated Thyroid Resection Procedures

100%
Sławeta N., Głuszek S., Heciak J.
Polish Journal of Surgery
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2013
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vol. 85
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issue 5
235-246
EN
Clinical and metabolic consequences of complicated thyroid resection procedures are rarely an object of complex analysis, and teams participating in treatment may have a very limited knowledge of them. The aim of the study was to assess clinical and metabolic consequences of complicated thyroid surgical procedures. Material and methods. In the years 2002-2007, 756 patients underwent surgery due to non-neoplastic thyroid diseases. Sixty-nine (9.1%) patients experienced complications manifesting as vocal cord paralysis and/or hypoparathyroidism. Follow-up examination was conducted in a group of 42 persons, which amounted to 61% of patients who experienced complications following thyroid surgical procedures. Follow-up examination, comprising assessment of morphotic blood elements, electrolyte, lipid and parathormone blood concentrations, thyroid hormone activity, respiratory function, vocal cord mobility, bone mineralization and ultrasound examination of the pocket left after thyroid resection, was conducted after the mean period of 43 months following surgery. Results. In the analyzed group, no significant differences in plasma electrolyte content were found (sodium, potassium, magnesium, calcium and phosphorus ions). In the group of patients with chronic hypoparathyroidism, no hypophosphatemia was observed, and there were no reports of concomitant nephrolithiasis or cataract. Increased cholesterol concentration was observed in the group of patients with chronic hypoparathyroidism and without hypoparathyroidism (p = 0.07). In 35% of patients with chronic vocal cord paralysis, abnormal results of spirometry tests were obtained. In the group of patients with chronic hypoparathyroidism, densitometry examination revealed higher T-score values compared with patients with transient hypoparathyroidism and vocal cord paralysis (p = 0.07). No bone mineralization disorders manifesting as pathological fractures were noted. Conclusions. The knowledge of clinical and metabolic consequences of complicated thyroid surgical procedures, due to their complexity, may be very limited among the members of both surgical teams and teams involved in management of complications. Development of a complication following thyroid surgery may be associated with significant homeostasis disorders, especially as regards calcium-phosphate metabolism, the skeletal system and the respiratory system. Such disorders can manifest long after the disease onset, only properly intensified and long-term management allows limitation of their extent.
2
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Intraoperative Parathyroid Hormone Level as a Predictor of Post-Thyroidectomy Hyproparathyrodism

88%
Lewandowicz M., Kuzdak K., Pasieka Z.
Polish Journal of Surgery
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2009
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vol. 81
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issue 8
340-347
EN
Hypoparathyroidism is the most common complication of thyroid surgery. Accurate treatment of this condition requires early diagnosis of patients at risk of hypocalcemia.The aim of the study was to evaluate the predictive value of intraoperative parathyroid hormone assessment in identification of affected subjects.Material and methods. Sixty five subjects participated in the prospective study. They underwent bilateral neck exploration with subtotal or total thyroidectomy. Parathormone (PTH) and calcium levels were assessed prior to surgery, intraoperatively and at different time-points following the operation.Results. In respect of the results, patients were allocated into 3 groups: (A) subjects with asymptomatic course; (B) subjects with perioperative symptomatic hypocalcemia; (C) subjects with prolonged symptomatic hypocalcemia. No differences between these groups were observed in the intraoperative calcium levels. Intraoperative parathormone (ioPTH) level was significantly lower in group C and at value minor of the reference range identified group C subjects with sensitivity and specificity of 100 and 91.5%, respectively. Mean intraoperative PTH level decrease (ΔioPTH) of 22.5% was observed. ΔioPTH rate was significantly higher (81.4%) in group C. This parameter presented sensitivity of 66.7% and specificity of 93.2% in identification of group C patients.Conclusions. Single intraoperative PTH level assessment identifies subjects at risk of postoperative hypoparathyroidism. Intraoperative drop of PTH (ΔioPTH) proves less sensitive. Intraoperative calcium levels cannot be regarded as a predictor of this complication.
3
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Early predictors of post – thyroidectomy hypoparathyroidism

88%
Sieniawski K., Kaczka K., Paduszyńska K., Fendler W., Tomasik B., Pomorski L.
Polish Journal of Surgery
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2016
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vol. 88(6)
540-555
EN
Thyroid surgery is the most commonly performed procedure in the field of endocrine surgery. Studies are still ongoing on the development of a single algorithm for diagnosis and care of patients at risk of postoperative hypoparathyroidism. The aim of the study was to determine the biochemical marker that would allow the most accurate diagnosis of patient groups at risk of developing hypoparathyroidism and to identify risk factors for this disorder. Material and methods. The prospective study included 142 consecutive patients undergoing total thyroidectomy for benign goiter from January 1st 2014 to December 31st 2015. Serum intact parathyroid hormone (iPTH), total calcium (Ca), phosphate (P), and magnesium (Mg) levels have been measured preoperatively and at 1, 6, 24, and 48 h postoperatively. Results. Clinical symptoms of hypoparathyroidism developed in 25 (17.6%) of 142 patients. The best diagnostic accuracy for hypoparathyroidism based on ROC curves was obtained for iPTH at 6h (AUC 0.942; 95% CI: 0.866-1.000, p<0.001) and its percentage change from baseline ΔiPTH at 6h (AUC 0.930; 95% CI: 0.858-1.000, p<0.001). In an multivariate analysis, the preoperative Ca level higher by 0.1 mmol/l, and iPTH level higher by 0.1 pmol/l were associated with a lower risk of hypoparathyroidism, by 68% (p=0.012) and 61% (p=0.007), respectively. A 1% decline in iPTH from baseline increased the risk of hypoparathyroidism by 15% (p<0.001). Conclusions. The most reliable markers indicating a high risk of postoperative hypoparathyroidism are the decline in ΔiPTH at 6h by > 65% or iPTH level at 6h <1.57 pmol /l. A postoperative decline in iPTH levels is an independent risk factor for the development of hypoparathyroidism. Preoperative higher concentrations of Ca and iPTH are protective factors for the development of this disorder.
4
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Perioperative calcium and vitamin D supplementation in patients undergoing thyroidectomy – literature review

75%
Grzegory A., Pomorski L.
Polish Journal of Surgery
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2018
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vol. 90(4)
46-50
EN
Introduction: Postoperative hypocalcemia is a narrow but significant problem for patients undergoing thyroid and parathyroid surgery. It is the most common complication after thyroidectomy. It is associated with transient or permanent hypoparathyroidism. It could potentially be life-threatening for patients and increases the costs of hospitalization. The aim of the study was to evaluate the results of studies that routinely administrated calcium and/or vitamin D during the postoperative period. Materials and Methods: In this article, a literature review – 15 studies that used routine perioperative calcium (7 studies), vitamin D (2 studies) and calcium with vitamin D (11 studies) supplementation was performed. Supplementation effectiveness in prevention of postoperative hypocalcemia was compared to no prophylaxis in 10 studies. Five studies compared the effect of combined administration (calcium and vitamin D) to calcium alone. The number of papers dealing with this problem is not particularly high. Results: Supplementation significantly decreased the rate of laboratory and symptomatic hypocalcemia. It was also effective in reducing the severity of symptoms. The combination of calcium with vitamin D was the most effective strategy. No hypercalcemia or parathyroid hormone inhibition was observed in the supplemented groups. Routine supplementation was less expensive than performing laboratory tests in the course of treatment of hypocalcemia. Conclusions: The results of analyzed studies showed the clinical and economic advantage of routine perioperative prophylactic supplementation of vitamin D and/or calcium as compared to no prophylaxis. However, the majority of studies showed a significant range of variability in patients’ characteristics. Numerous studies did not evaluate the preoperative 25-hydroxycholecalciferol level – a risk factor for postoperative hypocalcemia. Discussion: The use of routine prophylactic supplementation of calcium and vitamin D in the perioperative period can be useful in everyday clinical practice. Further research is needed to draw clear guidelines regarding prophylactic calcium and vitamin D therapy for patients after thyroidectomy.
5
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Hipokalcemia z towarzyszącymi łagodnymi zaburzeniami odporności i zmianami w ośrodkowym układzie nerwowym – opis przypadku pierwotnej niedoczynności przytarczyc

63%
Krakowska A., Hilczer M., Tkaczyk M.
Pediatria i Medycyna Rodzinna
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2011
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vol. 7
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issue 3
257-260
EN
Introduction: There is a huge variety of hypocalcaemia aetiologies. Out of all these reasons hypoparathyroidism is one of the rarest. The most common cause of this malfunction is accidental excision of parathyroid gland during thyroid gland surgery. Inflammation or metabolic disorders are very rare. When we diagnose hypoparathyroidism, polyendocrine syndromes must be always taken into account and we are obliged to check whether other endocrine glands work properly. Hypocalcaemia can be asymptomatic. However some most common signs of this disorder are: laryngospasm, muscle cramps (especially during physical effort), tetany, nutritional problems among infants, convulsions, paraesthesia, Trousseau and Chvostek symptoms, longer QT>450 ms. Aim of the study: We present the case of 8 year old child suffering from idiopathic hypoparathyroidism, epilepsy and immune deficiency. This case is quite interesting as the most spectacular hypocalcaemia symptom which tetany is, was initially taken for epilepsy. Epilepsy was diagnosed after the boy choked because of the braces which misplaced during the night. As a result his central nervous system suffered from short-lived oxygen deficiency. Maybe these two diseases (hypoparathyroidism and epilepsy) coexist or epilepsy was just a mask of severe hypocalcaemia? Conclusions: Diagnosing epilepsy we cannot omit tests concerning calcium and phosphate blood levels.
PL
Wstęp: Hipokalcemia ma bardzo zróżnicowaną etiologię. Niedoczynność przytarczyc jako jedna z jej przyczyn jest problemem niezwykle rzadkim. Zazwyczaj spotykamy się z niedoczynnością tego gruczołu w związku z przypadkowym usunięciem w trakcie operacji tarczycy. Bardzo rzadko mamy do czynienia ze zniszczeniem gruczołu przez proces zapalny czy chorobę spichrzeniową. W przypadku niedomogi przytarczyc należy wziąć pod uwagę również zespoły niedoczynności wielogruczołowej i ocenić funkcję innych gruczołów wydzielania wewnętrznego. Hipokalcemia może być bezobjawowa. Do najczęstszych symptomów należą: skurcz krtani, skurcze mięśni (zwłaszcza w czasie wysiłku fizycznego), tężyczka, problemy z karmieniem, drgawki, parestezje, objawy Chvostka i Trousseau, wydłużenie odstępu QT>450 ms. Cel pracy: Przedstawiamy przypadek kliniczny 8-letniego chłopca z idiopatyczną niedoczynnością przytarczyc oraz padaczką i zaburzeniem odporności. Jest on o tyle ciekawy, że obraz tej choroby, a konkretnie najbardziej spektakularny objaw hipokalcemii, jakim jest tężyczka, nałożył się na rozpoznaną wcześniej u chłopca padaczkę. Epilepsja pojawiła się po epizodzie zakrztuszenia aparatem ortodontycznym i wiązano ją z możliwym, krótkotrwałym niedotlenieniem ośrodkowego układu nerwowego. Czy te dwie wspomniane choroby współistnieją u naszego pacjenta, czy może wcześniej rozpoznana padaczka maskowała tylko ciężki niedobór wapnia u dziecka? Wnioski: Uwzględnienie w badaniach laboratoryjnych elementów gospodarki wapniowo-fosforanowej powinno stanowić stały element w procesie diagnozowania padaczki.
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