Incidence and Risk Factors for Post-thyroidectomy Hypocalcemia

Authors

  • Michael Conrad Tongol Section of Endocrinology, Diabetes and Metabolism, St. Luke's Medical Center Quezon City Philippines
  • Roberto Mirasol Section of Endocrinology, Diabetes and Metabolism, St. Luke's Medical Center Quezon City Philippines

Keywords:

hypocalcemia, thyroidectomy, incidence, risk factor

Abstract

*Visual Abstract prepared by Dr. Ma. Princess Landicho-Kanapi

Objectives. This study aimed to determine the incidence and risk factors for post-thyroidectomy hypocalcemia.

Methodology. This was a retrospective study of 242 patients who underwent total or completion thyroidectomy from 2011-2014 at the St. Luke’s Medical Center, Quezon City, Philippines. The overall and type-specific incidences of hypocalcemia were determined. Patient and surgery-related factors were assessed and hypocalcemic events described.

Results. Overall incidence of hypocalcemia is 11.98% distributed into symptomatic (10.74%) and asymptomatic (1.24%). The following patient-related factors were not found to be significantly associated with hypocalcemia: age, gender, thyroid disease and thyroid gland weight. Among surgery-related factors, the presence of concomitant complications of thyroidectomy (hoarseness and/or hematoma) and inadvertent parathyroidectomy were significantly associated with hypocalcemia both in the univariate [p=0.046; OR 2.369 (95%CI: 0.995-5.643) and p=0.027; OR 2.426 (95%CI: 1.084-5.432), respectively] and multivariate analyses [p=0.025; OR 2.842 (95%CI: 1.142-7.069) and p=0.013; OR 2.941 (95%CI: 1.252-6.907), respectively]. Other surgery-related factors were not found to be significantly associated with hypocalcemia: extent of thyroidectomy [total vs completion]; neck dissection; surgery duration (hours); and surgeon [consultant vs. trainee]. Among those with symptomatic hypocalcemia, manifestations occurred 29.85±23.07 hours post-operatively and these were: Chvostek’s (80.8%), acral paresthesia (76.9%), perioral numbness (46.1%), carpopedal spasm (15.3%), Trousseau’s (7.7%) and cramps (3.8%). Those who presented with manifestations of hypocalcemia but with normal serum iCa post-operatively comprised 33.9% of the study population and the majority presented with Chvostek’s sign (52%) and acral paresthesia (50%).

Conclusion. In this study, hoarseness and/or hematoma and inadvertent parathyroidectomy are risk factors for post-thyroidectomy hypocalcemia. Closer monitoring of these patients for hypocalcemia may be necessary.

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References

Mirnezami R, Sahai A, Symes A, Jeddy T. Day-case and short-stay surgery: The future for thyroidectomy? Int J Clin Pract. 2007;61(7):1216-22. http://dx.doi.org/10.1111/j.1742-1241.2006.01234.x.

Hopkins B, Steward D. Outpatient thyroid surgery and the advances making it possible. Curr Opin Otolaryngol Head Neck Surg. 2009;17(2):95-9. PMID:19373959.

McLeod IK, Arciero C, Noordzij JP, et al. The use of rapid parathyroid hor-mone assay in predicting postoperative hypocalcemia after total or comple¬tion thyroidectomy. Thyroid. 2006;16(3):259–65. http://dx.doi.org/10.1089/thy.2006.16.259.

Abboud B, Sargi Z, Akkam M, Sleilaty F. Risk factors for post thyroidectomy hypocalcemia. J Am Coll Surg. 2002;195(4):456-61. http://dx.doi.org/10.1016/S1072-7515(02)01310-8.

Rosato L, Avenia N, Bernante P, et al. Complications of thyroid surgery: Analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg. 2004;28(3):271-6.

http://dx.doi.org/10.1007/s00268-003-6903-1.

Tolone S, Roberto R, del Genio G, et al. The impact of age and oral calcium and vitamin D supplements on postoperative hypocalcemia after total thyroidectomy. A prospective study. BMC Surgery. 2013;13(Suppl 2):S11. http://dx.doi.org/10.1186/1471-2482-13-S2-S11.

Baldassarre RL, Chang DC, Brumund, KT, and Bouvet M. Predictors of hypocalcemia after thyroidectomy: Results from the nationwide inpatient sample international scholarly research network. ISRN Surgery. 2012(2012), Article ID 838614.

Alhefdhi A, Mazeh H and Chen H. Role of postoperative vitamin D and/or calcium routine supplementation in preventing hypocalcemia after thyroidectomy: A systematic review and meta-analysis. The Oncologist. 2013;18(5):533–542. http://dx.doi.org/10.1634/theoncologist.2012-0283.

Pfleiderer, AG, Ahmad N, Draper, 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(2):140–6. http://dx.doi.org/10.1308/003588409X359349.

McHenry CR, Piotrowski JJ. Thyroidectomy in patients with marked thyroid enlargament: Airway management, morbidity and outcome. Am J Surg 1994;60(8):586-91. PMID:8030813.

Zambudio AR, Rodriguez J, Riquelme J, Soria T, Canteras M, Parrilla P. Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg. 2004;240(1):18-25. PMID: 15213613.

Celzo MFI, Picorro MAL, Alcances LRA, Jasul G. Clinical predictors of post-thyroidectomy hypocalcemia: A retrospective review. Philipp J Intern Med. 2005;43(6): 331-41.

Kim JP, Park JJ, Son HY, Kim RB, Kim HY, Woo, SH. Effectiveness of an i-PTH measurement in predicting post thyroidectomy hypocalcemia: Prospective controlled study. Yonsei Med J. 2013;54(3):637-42. http://dx.doi.org/10.3349/ymj.2013.54.3.637.

Tredici P, Grosso E, Gibelli B, Massaro MA, Arrigoni C, Tradati N. Identification of patients at high risk for hypocalcemia after total thyroidectomy. ACTA Otorhinolaryngologica Ital. 2011;31(3):144-8. PMCID: PMC3185817.

Kim JH, Chung MK, Son YI. Reliable early prediction for different types of post-thyroidectomy hypocalcemia. Clin Exp Otorhinolaryngol. 2011;4(2): 95-100. http://dx.doi.org/10.3342/ceo.2011.4.2.95.

Mishra A, Agarwal G, Agarwal A, and Mishra SK. Safety and efficacy of total thyroidectomy in hands of endocrine surgery trainees. Am J Surg. 1999; 178(5): 377–80. http://dx.doi.org/10.1016/S0002-9610(99)00196-8.

Bergenfelz A, Jansson S, Kristoffersson A, et al. Complications to thyroid surgery: Results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg. 2008;393(5):667–73. http://dx.doi.org/10.1007/s00423-008-0366-7.

Fernando R, Chandrasinghe PC, Bandara M, Renuka MBS, Athulugama NS. Hypocalcemia and hoarseness following total thyroidectomy for benign disease: Relationship of incidence to the size of the gland. WJOES. 2011;3(1):7-9. http://dx.doi.org/10.5005/jp-journals-10002-1046.

Published

2016-05-19

How to Cite

Tongol, M. C., & Mirasol, R. (2016). Incidence and Risk Factors for Post-thyroidectomy Hypocalcemia. Journal of the ASEAN Federation of Endocrine Societies, 31(1), 30. Retrieved from https://asean-endocrinejournal.org/index.php/JAFES/article/view/292

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