Can hypocalcemia occur In the early postoperative period be predict in total thyroidectomy patients? A prospective study

Year 2024, Volume: 17 Issue: 1, 17 - 23, 08.01.2024

Mehmet Karahan , Serkan Fatih Yeğen

Abstract

One of the most important complications following total thyroidectomy is hypocalcemia. Although 1 to 2% of these are permanent, the rate of temporary hypocalcemia is quite high. In various studies this rate is re-ported as 10-40%. Therefore, prevention and early diagnosis of hypocalcemia is important. Serum phosphate responds rapidly to changes in circulating PTH levels, and its measurement is readily available in all hospitals. The aim of this study is to compare the value of phosphate measures, which may predict the development of hypocalcemia in the early post operative period following total thyroidectomy, to iPTH and Ca measurements.
In this prospective study, patients who underwent total thyroidectomy in our clinic in a one year, inde-pendent of diagnosis were included in a consecutive manner. Calcium measurements were made immediately when symptoms of hypocalcemia developed or 24 hours postoperatively in symptom free patients and at day 5 postoperatively to evaluate late hypocalcemia. In our study calcium levels under 8 mg/dl were accepted as hypocalcemia and iPTH levels less than 10 pg/dl were accepted as below normal levels.
120 patients who underwent total thyroidectomy in our clinic were included in this study. The hypocal-cemic group included 4 patients with hypocalcemia occurring in the first 24 hours post op, 31 patients at 24 hours and 9 cases were hypocalcemia occurred 5 days postop after the patients had normal calcium and were discharged from the hospital. The normocalcemia group had 76 patients (63,33).
Temporary hypocalcemia occurs in 10% to 40% of patients after total thyroidectomy. The main ac-cepted reason of this situation that occurs following thyroidectomy is parathyroid insufficiency. Even though one of the important goals in modern thyroid surgery is protecting the functions of the parathyroid glands, hy-pocalcemia following thyroidectoy remains a problem. For this reason, detecting patients that may become hypocalcemic in the postoperative early phase and preventing its occurrence with appropriate treatment will decrease the post operative duration of hospitalization. This being the case, it has made us think that phosphate may be a usable measure to detect post thyroidectomy hypocalcemia earlier.
In light of our findings, we suggest that phosphate levels measured in the early postoperative phase of total thyroidectomy, can be used to predict the development of hypocalcemia.

Keywords

Hypocalcemia, Thyroidectomy, Phosphate

Ethical Statement

Potansiyel önyargıya veya çıkar çatışmasına yol açabilecek mali, danışman ve kurumsal çıkarlar da dahil olmak üzere mevcut veya potansiyel çıkar çatışmaları yoktur. Gönderilen çalışma için kişi veya kurumlardan alınan herhangi mali hibe veya destek yoktur.

Thanks

Bilime ve Bilim İnsanlarına katkılarınız için teşekkürler

References

• 1. Lindblom P, Westerdahl J, Bergenfelz A. Low parathyroid hormone levels after thyroid surgery: a feasible predictor of hypocalcemia. Surgery. 2002;131(5):515-520.
• 2. Wingert DJ, Friesen SR, Iliopoulos JI, Pierce GE, Thomas JH, Hermreck AS. Post-thyroidectomy hypocalcemia: incidence and risk factors. The American journal of surgery. 1986;152(6):606-610.
• 3. Wang Y-h, Bhandari A, Yang F, Zhang W, Xue L-j, Liu H, et al. Risk factors for hypocalcemia and hypoparathyroidism following thyroidectomy: a retrospective Chinese population study. Cancer management and research. 2017;9:627.
• 4. Rosario P, Calsolari M. Usefulness of serum calcitonin in patients without a suspicious history of medullary thyroid carcinoma and with thyroid nodules without an indication for fine-needle aspiration or with benign cytology. Hormone and Metabolic Research. 2016;48(06):372-376.
• 5. Lombardi CP, Raffaelli M, Princi P, Santini S, Boscherini M, De Crea C et al. Early prediction of post thyroidectomy hypocalcemia by one single iPTH measurement. Surgery. 2004;136(6):1236-1241.
• 6. Sam AH, Dhillo WS, Donaldson M, Moolla A, Meeran K, Tolley NS, et al. Serum phosphate predicts temporary hypocalcemia following thyroidectomy. Clinical endocrinology. 2011;74(3):388-393.
• 7. Hundahl SA, Cady B, Cunningham MP, Mazza-ferri E, McKee RF, Rosai J, et al. Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the United States during 1996: an American College of Surgeons Commission on Cancer patient care evaluation study. Cancer. 2000;89(1):202-217.
• 8. Serpell JW, Phan D. Safety of total thyroidectomy. ANZ J Surgery 2007;77(1‐2):15-21.
• 9. Henry J, Gramatica L, Denizot A, Kvachenyuk A, Puccini M, Defechereux T. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbeck's archives of surgery. 1998;383(2):167-169.
• 10. Kaplan E, Angelos P, Applewhite M, Mercier F, Grogan RH. Surgery of the thyroid. Endotext [Internet]. MDText. com, Inc.; 2015.
• 11. Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau J-L et al. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surgery. 1998;22(7):718-724.
• 12. Lo CY, Luk JM, Tam SC. Applicability of intraoperative parathyroid hormone assay during thyroidectomy. Annals of surgery. 2002;236(5):564.
• 13. Payne RJ, Hier MP, Black MJ, Tamilia M, Young J, MacNamara E. Postoperative parathyroid hormone level as a predictor of post-thyroidectomy hypocalcemia. J Otolaryngo-logy. 2003;32(6).
• 14. Richards ML, Bingener-Casey J, Pierce D, Stro-del WE, Sirinek KR. Intraoperative parathyroid hormone assay: an accurate predictor of symptomatic hypocalcemia following thyroidectomy. Arch. Surgery 2003;138(6):632-636.
• 15. Lam A, Kerr PD. Parathyroid hormone: an early predictor of postthyroidectomy hypocalcemia. The Laryngoscope. 2003;113(12):2196-2200.
• 16. Payne RJ, Hier MP, Tamilia M, Namara EM, Young J, Black MJ. Same‐day discharge after total thyroidectomy: the value of 6‐hour serum parathyroid hormone and calcium levels. Head & Neck. 2005;27(1):1-7.
• 17. Grodski S, Serpell J. Evidence for the role of perioperative PTH measurement after total thyroidectomy as a predictor of hypocalcemia. World J Surgery. 2008;32(7):1367-1373.
• 18. Toniato A, Boschin IM, Piotto A, Pelizzo M, Sartori P. Thyroidectomy and parathyroid hormone: tracing hypocalcemia-prone patients. Am J Surgery. 2008;196(2):285-288.
• 19. Noordzij JP, Lee SL, Bernet VJ, Payne RJ, Co-hen SM, McLeod IK, et al. Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies. Journal of the American College of Surgeons. 2007;205(6):748-754.
• 20. Beutner EH, Munson PL. Time course of urinary excretion of inorganic phosphate by rats after parathyroidectomy and after injection of parathyroid extract. Endocrinology. 1960;66:610-616.
• 21. Ellsworth R. Studies on the physiology of the parathyroid glands: V. Action of parathyroid extract on the renal threshold for phosphorus. The Journal of Clinical Investigation. 1932;11(5):1011-1017.
• 22. Košec A, Hergešić F, Matovinović F, Rašić I, Vagić D, Bedeković V. Identifying early post-operative serum parathyroid hormone levels as predictors of hypocalcemia after total thyroidectomy: A prospective non-randomized study. American J Otolaryngology. 2020:102416.
• 23. Park I, Rhu J, Woo J-W, Choi J-H, Kim JS, Kim J-H. Preserving parathyroid gland vasculature to reduce post-thyroidectomy hypocalcemia. World J Surgery 2016;40(6):1382-1389.
• 24. Kandil E, Noureldine SI, Abbas A, Tufano RP. The impact of surgical volume on patient outcomes following thyroid surgery. Surgery 2013;154(6):1346-1353.
• 25. Sands NB, Payne RJ, Côté V, Hier MP, Black MJ, Tamilia M. Female gender as a risk factor for transient post-thyroidectomy hypocalcemia. Otolaryngology. Head and Neck Surgery. 2011;145(4):561-564.