Abstract
Hypocalcemia is the most common complication after total thyroidectomy. The aim of this study was to determine the predictors of postoperative hypocalcemia requiring augmentation of routine calcium supplementation. Prospectively collected data of 61 patients who underwent total thyroidectomy from December 2018 to June 2019 was considered for the study. All patients received calcium and vitamin D supplementation after the surgery. In the postoperative period, serum calcium and parathormone (PTH) levels were monitored. The need of additional oral or intravenous (i.v.) calcium supplementation was evaluated as an outcome measure. This cohort comprised 61 patients with median age of 46 years (range 16–80 years) and 49 (80%) females. Central compartment clearance (CCC) was done in 32 patients. Escalation to increased oral and intravenous calcium was required in 15 patients (24.6%) and 2 patients (3.3%), respectively. Serum parathormone level of 11.5 pg/ml on postoperative day 1 predicted the requirement of additional calcium with a sensitivity of 82.4% and specificity of 77.3%. On univariate analysis, serum PTH (p < 0.001), CCC (p = 0.018), and intraoperative parathyroid gland congestion (p = 0.021) predicted the need for escalation of calcium supplementation. On multivariate analysis, only serum PTH showed a significant impact on the need for augmentation of calcium supplementation (p = 0.003). The need for calcium dose augmentation after total thyroidectomy was significantly associated with CCC, parathyroid gland congestion, and serum PTH levels. Intraoperative identification of parathyroid gland congestion and postoperative serum PTH levels is effective in predicting postoperative hypocalcemia with implications on time and cost.
Similar content being viewed by others
References
Walker Harris V, de Beur J (2009) Postoperative hypoparathyroidism: medical and surgical therapeutic options. Thyroid 19:967–973
Toniato A, Boschin IM, Piotto A, Pelizzo M, Sartori P (2008) Thyroidectomy and parathyroid hormone: tracing hypocalcemia-prone patients. Am J Surg 196:285–288
Abboud B, Sargi Z, Akkam M, Sleilaty F (2002) Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg 195:456–461
Tartaglia F, Sgueglia M, Muhaya A, Cresti R, Mulas MM, Turriziani V, Campana FP (2003) Complications in total thyroidectomy: our experience and a number of considerations. Chir Ital 55:499–510
Maitland R, Miell J (2010) Hypocalcemia post total thyroidectomy: a clinical experience. Endocrine 21:50
Asari R, Passeler C, Kaczirek K, Scheuba C, Niederle B (2008) Hypoparathyroidism after total thyroidectomy: a prospective study. Arch Surg 143:132–138
McHenry CR, Speroff T, Wentworth D, Murphy T (1994) Risk factors for postthyroidectomy hypocalcemia. Surgery 116:641–648
Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL et al (1998) Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 22:718–724
Erbil Y, Barbaros U, Temel B, Turkoglu U, Issever H, Bozbora A et al (2009) The impact of age, vitamin D(3) level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy. Am J Surg 197:439–446
Sywak MS, Palazzo FF, Yeh M, Wilkinson M, Snook K, Sidhu SB, Delbridge LW (2007) Parathyroid hormone assay predicts hypocalcemia after total thyroidectomy. ANZ J Surg 77:667–670
Rubin MR, Dempster DW, Zhou H, Shane E, Nickolas T, Sliney J Jr et al (2008) Human chorionic gonadotropin measurements in parathyroid carcinoma. Eur J Endocrinol 159:469–474
Rubin MR, Bilezikian JP (2010) Hypoparathyroidism: clinical features, skeletal microstructure and parathyroid hormone replacement. Arq Bras Endocrinol Metabol 54:220–226
Page C, Strunski V (2007) Parathyroid risk in total thyroidectomy for bilateral, benign, multinodular goiter: report of 351 surgical cases. J Laryngol Otol 121:237–241
Bellantone R, Lombardi CP, Raffaelli M, Boscherini M, Alesina PF, De Crea C et al (2002) Is routine supplementation therapy (calcium and vitamin D) useful after total thyroidectomy? Surgery 132:1109–1112
Warren FM, Andersen PE, Wax MK, Cohen JI (2004) Perioperative parathyroid hormone levels in thyroid surgery: preliminary report. Laryngoscope 114:689–693
Roh JL, Park JY, Park CI (2009) Prevention of postoperative hypocalcaemia with routine oral calcium and vitamin d supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection. Cancer 115:251–258
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Verma, H., Arun, P., Sharan, R. et al. Risk of Hypocalcemia and the Need to Augment Calcium Supplementation After Total Thyroidectomy. Indian J Surg Oncol 13, 7–10 (2022). https://doi.org/10.1007/s13193-020-01098-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13193-020-01098-3