Clinical and laboratorial correlation of postoperative hypocalcemia after extensive thyroidectomy

Abstract

The medicai records of 84 patients submitted to extensive thyroidectomy from January 1991 to April1995 were reviewed and the data was analyzed in order to verify a correlation between postoperative laboratories results and physical findings suggestive of hypocalcemia. It was verified that there was hypocalcemia in 51.2 percent of the patients, of which only 18.6 percent presented symptonis. It was concluded that asymptomatic hypocalcemia is frequent in extensive thyroidectomy and a routine screening for serum calcium in the postoperative period following thyroidectomy and calcium reposition must be systematic.UNITERMS: Thyroid, hypocalcemia, thyroidectomy. INTROOUCTIONT he thyroid can be affected by many diseases which can be treated by surgery. The extent of surgical resection of the thyroid gland has been dictated by the pathology and the site of the disease. Thyroidectomy lnay cause various complications,I-4 one of which is hypocalcelnia. lt is not unusual for patients undergoing operative procedures on the thyroid gland to experience a transient 01' pernlanent drop in serUln calciuln following operation.The causal lnechanisln of this hypocalcelnia has still not been cOlnpletely elucidated; however, this lnetabolic disorder is attributed to surgical dalnage inflicted on the parathyroid glands during thyroidectolny; for example, devascu larization, tralllna 01' exeresi s, .01' to local postoperative cOlnplications such as compromise of the blood supply of the parathyroid, I.2,ó-IO edema, hematomas, and infectionY Other causes such as parathyroid suppression due to reabsorption of bone calcium in hypelthyroidism

Study of hypocalcemia and its risk factors in post thyroidectomy among a sample of Iraqi patients

“…Hypocalcemia is more incessant in broad thyroidectomy when contrasted with minor resections of the thyroid organ, in the ligation of the subpar thyroid supply route and has been identified with the specialist's understanding. 6 The body of a youthful grown-up human contains around 1100g (27.5mol) of calcium. Ninety-nine percent of the calcium is in the skeleton.…”

Changes of serum calcium level following thyroid surgery - reasons and clinical implications

“…In the development of mild and transient hypocalcemia, hemodilution (Bourrel et al, 1994;Demeester-Mirkine et al, 1992), decrease of protein level (Sortino et al, 1994), abnormal release of calcitonin (Cakmakli et al, 1996;See and Soo, 1997) and reduction of vitamin D level (Bergenfelz and Ahren, 1993) may all play a role. Other risk factors can be: preoperatively increased free thyroxin level resulting in ªhungry bone syndromeº after surgery (Yamashita et al, 1997;See and Soo, 1997), extended substernal goiter (Goudet et al, 1996;al-Sulimann et al, 1997), neoplasia, extended or longlasting operations (Yamashita et al, 1997;Torre et al, 1995;McHenry et al, 1994;Uccheddu et al, 1996;Goncalves et al, 1997), reoperations (Wilson et al, 1998;Peix et al, 1997), surgical specialty (Burge et al, 1998). Nevertheless, other authors did not find any difference in the complications e.g.…”

Malignant Thyroid Disease; Hypocalcaemia Following Thyroid Surgery

“…Study by Rosato L et al 16 from Italy mentioned postoperative hypocalcemia in 9.0% patients with total thyroidectomy, in 1.9% following unilateral thyroid Lobectomy, 14.4% following thyroidectomy plus unilateral neck dissection, 23.4% following thyroidectomy plus bilateral neck dissection, 9.6% following complete substernal thyroidectomy, 3.4% following partial substernal thyroidectomy, 6.5% following substernal thyroidectomy, and 3.4% following isthmectomy or otherwise unspecified partial thyroidectomy. Goncalves AJ et al 13 in their study at Sao Paulo mentioned unilateral subtotal thyroidectomy associated with contralateral hemithyroidectomy was the most prevalent surgical resection causing hypocalcemia. It occurred in 66.6% of the cases followed by total thyroidectomy in 53.4% and by bilateral subtotal thyroidectomy in 35.3% cases.…”