Hypocalcemia Following Total Thyroidectomy

Year 2018, , 36 - 44, 01.01.2018

Fatih Çiftçi

https://doi.org/10.5505/kjms.2017.82542

Abstract

Aim: Hypocalcemia following total thyroidectomy is one of the clinically relevant complication for clinicians. In this study, we examined the factors associated with development of hypocalcemia after total thyroidectomy. 
Material and Method: We studied gender, age, preoperative diagnosis, operative time, hormonal status, existence of parathyroid gland injury at the operation, parathyroid gland auto-transplantation, amount of bleeding at the operation and preoperative use of antithyroid drugs with the patients. In the first day after operation serum phosphor, calcium, parathyroid hormone levels were obtained. In the second day, phosphor and calcium were measured. The chi-square test was used for categorical variables. Logistic regression model was used to define the risk of hypocalcemia in the univariate analysis. 
Results: Hypocalcemia were observed in 56 of 200 patients. Female gender, preoperative diagnosis of toxic nodular goitre, and of thyroid cancer, parathyroid injury, nodule size <3cm, and auto-transplantation were found to be associated with hypocalcemia in logistic regression analysis.
Conclusion: The risk factors related with hypocalcemia were found to be gender, parathyroid gland injury, preoperative diagnosis, nodule size, D vitamin deficiency. Hypocalcemia after total thyroidectomy seems to be a multifactorial problem with a rich spectrum of aetiology.

Keywords

Hypocalcaemia, goitre, parathyroid, thyroidectomy

Total Tiroidektomi Sonrası Hipokalsemi

Abstract

Amaç: Hipokalsemi total tiroidektomi sonrası gelişen en önemli komplikasyonlardan biridir. Çalışmada total tiroidektomi sonrası hipokalsemi gelişimine yol açan nedenler incelendi. 
Materyal ve Metot: Hastalarda yaş, cinsiyet, preoperatif tanı, hormonal durum, operasyon süresi, ameliyat sırasında paratiroid bezi hasarı varlığı, paratiroid bezi oto transplantasyonu, preoperatif olarak antitiroid ilaç kullanımını ve ameliyat sırasında kanama miktarı gözden geçirildi. Kategorik değişkenleri analiz etmek icin Kikare testi kullanıldı. Tek değişkenli analizde hipokalsemi riskini saptamak icin lojistik regresyon modeli kullanıldı. 
Bulgular: Total tiroidektomi yapılan 200 hastanın 56’sında hipokalsemi gelişti. Kadın cinsiyeti, preoperatif olarak tiroid kanseri ve toksik nodüler guatr teşhisi konulması, nodül büyüklüğünün < 3 cm olması, düşük D vitamin düzeyi, paratiroid hasarı gibi faktörler hipokalsemi ile ilişkili bulundu. 
Sonuç: Cinsiyet, preoperatif tanı, paratiroid gland hasarı, nodül büyüklüğü ve D vitamini eksikliği hipokalsemi ile ilişkilidir. Bu komplikasyonun gelişiminde geniş spektrumda multifaktöryel etiolojilerin 
spektrumda multifaktöryel etiolojilerin sözkonusu olduğu düşünüldü.

Keywords

Hipokalsemi, guatr, paratiroid, tiroidektomi

References

• 1- Çağlayan K, Çelik A. Benign tiroid hastalığında ameliyat yöntemleri ve komplikasyonların incelenmesi: Tiroidektomi ve komplikasyonları. Cerrahi Derg 2010; 26: 141-145.
• 2- Debry C, Schmitt E, Senéchal G, Silisté CD, Quevauvilliers J, Renou G. Analysis of thyroid surgery: recurrent paralysis et hypoparathyroidism. On a series of 588 cases. Ann Otolaryngol Chir Cervicofac.1995;112:211–7.
• 3- Ay A, Ay AA, Kaptanoğlu B, Kısmet K. Selim tiroid hastalıklarında total tiroidektominin etkinliği ve güvenilirliği. Endokrinolojide Diyalog 2010;7:127-132.
• 4- Gozu H, Avsar M, Bircan R, et al. Mutations in the thyrotropin receptor signal transduction pathway in the hyperfunctioning thyroid nodules from multinodular goiters: a study in the Turkish population. Endocr J.2005;52:577–85.
• 5- Ugurlu S, Caglar E, Yesim TE, Tanrikulu E, Can G, Kadioglu P. Evaluation of thyroid nodules in Turkish population. Intern Med. 2008;47:205–9.
• 6- Ozata M, Salk M, Aydin A, et al. Iodine and zinc, but not selenium and copper, deficiency exists in a male Turkish population with endemic goiter. Biol Trace Elem Res. 1999;69:211–6.
• 7- Gonçalves Filho J, Kowalski LP. Surgical complications after thyroid surgery performed in a cancer hospital. Otolaryngol Head Neck Surg. 2005;132:490–4.
• 8- Abboud B, Sargi Z, Akkam M, Sleilaty F. Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg. 2002;195:456– 61.
• 9- Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroidsurgery: a multivariate analysis of 5846 consecutive patients. Surgery. 2003;133:180– 5.
• 10- Öztürk G, Akçay MN, Basoğlu M, et al. Thyroidectomy for benign thyroid disease in patients with advanced ages: clinical experience. Endokrinolojide Diyalog. 2009;6:14–8.
• 11- 11- Sasson AR, Pingpank JF, Jr, Wetherington RW, Hanlon AL, Ridge JA. Incidental parathyroidectomy during thyroid surgery does not cause transient symptomatic hypocalcemia. Arch Otolaryngol Head Neck Surg. 2001;127:304–8.
• 12- Alimoglu O, Akdag M, Sahin M, et al. Comparison of surgical techniques for treatment of benign toxic multinodular goiter. World J Surg 2005;29:921-924.
• 13- Cranshaw IM, Moss D, Whineray-Kelly E, Harman CR. Intraoperative parathormone measurement from the internal jugular vein predicts post-thyroidectomy hypocalcaemia. Langenbecks Arch Surg.2007;392:699–702.
• 14- Lombardi CP, Raffaelli M, De Crea C, et al. Complications in thyroid surgery. Minerva Chir 2007;62:395-408.
• 15- Thomusch O, Machens A, Sekulla C, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 2000;24:1335.
• 16- Ünal B, Bozkurt B, Karabeyoğlu M, et al. Tiroid cerrahisinde komplikasyonları etkileyen faktörler: 1022 olgunun analizi. Endokrinolojide Diyalog. 2008;2:38–43.
• 17- Castro MR, Gharib H. Thyroid nodules and cancer. When to wait and watch, when to refer. Postgrad Med 2000;107:113-116.
• 18- Akgün YA, Öngören AU, Kuru S, et al. Tiroid cerrahisi sonrası tetani. Tr J Med Sci.2007;1:80–5.
• 19- Palazzo FF, Sywak MS, Sidhu SB, et al. Parathyroid autotransplantation during total thyroidectomy-does the number of glands transplanted affect outcome? World J Surg. 2005;29:629–31.
• 20- Payne RJ, Hier MP, Tamilia M, Young J, NacMara E, Black MJ. Postoperative parathyroid hormone level as a predictor of postthyroidectomy hypocalcemia. J Otolaryngol 2003;32: 362-367.
• 21- Akçay MN, Öztürk G, Akçay G, et al. Noduler guatr nedeniyle total tiroidektomi yapılan hastalarda cerrahın tecrübesiyle postoperatif hipokalsemi arasındaki ilişki. Endokrinolojide Diyalog. 2008;5:317–8.
• 22- Hatun Ş, Bereket A, Çalikoglu AS, et al. Günümüzde D vitamini yetersizliği ve nutrisyonel rikets. Çocuk Sağl Hast Derg 2003;46:224–41.
• 23- Karadavut KI, Başaran A, Çakçı A. Osteoporoz tedavisinde vita-min D’nin yeri. Tr J Geriatr 2002;5:115–22.
• 24- Kurukahvecioğlu O, Karamercan A, Akın M, et al. Potential benefit of oral calcium/vitamin D administration for prevention of symptomatic hypocalcemia after total thyroidectomy. Endocr Regul. 2007; 41: 35–9
• 25- Roh JL, Park CI. Routine oral calcium and vitamin D supplements for prevention of hypocalcemia after total thyroidectomy. Am J Surg. 2006;192:675–8.
• 26- Pattou F, Combemale F, Fabre S, et al. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 1998; 22: 718-720
• 27- Erbil Y, Bozbora A, Özbey N, et al. Predictive value of age and serum parathormone and vitamin D3 levels for postoperative hypocalcemia after total thyroidectomy for nontoxic multi-nodular goiter. Arch Surg.2007;142:1182–7.