In the second study, 350 adult patients > 18 years of age had a near-total, subtotal, or total thyroidectomy over an 8 year period by a single surgeon, mainly for benign disease [only 14% were for Graves’ disease]. Almost 1/3 of patients developed temporary hypoparathyroidism, but only 4% had permanent hypoparathyroidism, all but one of which was not severe. An average of 2.28 parathyroid glands were identified by the surgeon at the time of thyroid surgery. No parathyroid glands were found in 20 patients, 1 in 16 patients, 2 in 126 patients, 3 in 114 patients, and 4 in 41 patients. Central node dissection for cancer and parathyroid autotransplantation increased the risk of temporary and permanent hypoparathyroidism.
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
These papers show that mild temporary hypoparathyroidism after surgery is common in both children and adults. While permanent hypoparathyroidism is rare, it appears to be more common in children and teens than initially reported and is more common after longer, more extensive surgery. Even though it is recommended that the parathyroid glands be identified during surgery, not all parathyroid glands can be identified if the search for them is confined to those that are in the usual locations. Hypoparathyroidism is a chronic illness that greatly impairs quality of life and research should to done to prevent as well as improve treatment of the disease.
— Melanie Goldfarb, MD
The two most common early complications of thyroid surgery are hypocalcemia [20–30%] and recurrent laryngeal nerve injury [5–11%]. Bilateral recurrent nerve paralysis resulting in adduction of the vocal cords is a rare life-threatening complication [occurring in less than 0.1% of cases that requires emergency management. Prevention of complications depends on careful operative technique and is enhanced for some teams by the use of specific techniques such as intraoperative neuromonitoring. Postsurgical hypocalcemia is managed by the administration of calcium plus vitamin D for at least 10 days. Recurrent laryngeal nerve paralysis recovers in most cases, and no invasive therapy should be performed for at least six months, except for emergency presentations; laryngeal surgery techniques may offer significant improvement if phonation or respiratory sequelae persist beyond six months, but the results are inconsistent. There should be a systematic strategy for detection of complications after thyroidectomy involving a multidisciplinary approach.
Thyroidectomy is one of the common endocrinological surgeries for the treatment of thyroid disorders. Hypocalcemia is the potential complication after thyroidectomy, where is persistency can lead to serious systemic effects. The aim of this study is to evaluate the incidence of hypocalcemia in thyroidectomy patients.
Methods
In this cross-sectional study, patients referred to [XXX] for thyroidectomy from 2019 to 2020 were enrolled. Preoperative serum calcium and postoperative 24- and 48-h calcium levels were evaluated in these patients. Demographic data [sex and gender], calcium levels, type of thyroidectomy and duration of surgery was recorded for all the patients. SPSS v22 was used for statistical analysis. P 50% of patients with iPTH levels of < 10 pg/mL had a CSC of > 8 mg/dL [2 mmol/L] on the first posoperative morning [40].
Other lab tests are important in the evaluation of the patient suspected with this condition: [9,10,22,33,38]
- Serum phosphorus levels: May be increased in hypoparathyroidism, but low in hungry bone syndrome.
- Vitamin 25 hydroxy-D3: Levels in the insufficiency or deficiency ranges contribute to hypocalcaemia.
- Serum magnesium: Low levels compromise management of hypocalcemia, normal levels are required for proper PTH secretion.
- In some cases, with unexpected clinical complications is important to assess acid-base status as the presence of alkalosis increases the binding sites of the albumin to calcium, thus reducing the proportion of free calcium and causing symptoms of hypocalcemia; in these cases, measurement of CSC is not useful, and determination of ionized calcium is highly recommended.
Predictive factors of postsurgical hypoparathyroidism:
Serum iPTH levels take before, during and after thyroidectomy have been evaluated in different studies as a predictive factor for mild to severe post-surgical hypocalcemia and post-surgical hypoparathyroidism.
In a prospective multicentric study, it was found that preoperative iPTH levels equal to or higher than 47,9 pg/mL [5 pmol/L] were a predicting factor for recovery of parathyroid function [11], however, in a meta-analysis including 115 observational studies, the iPTH taken before surgery had no predictive value by itself in the multivariate analysis [31].
The decrease of the postoperative iPTH value compared with the preoperative, has been proven as a predicting factor of transient and permanent hypocalcemia [11,20,31]. Different values of iPTH defined as threshold taken at different latency times which can be as early as 5 minutes after thyroidectomy [intraoperative iPTH], in the first post-surgical hour [peri-operative iPTH] or at 24 hours post-surgical [post-operative iPTH], have been reported. Regarding levels of intraoperative iPTH, values