Comparison of the Incidence of Postoperative Hypocalcemia following Total Thyroidectomy vs Completion Thyroidectomy

Merchavy, Shlomo; Marom, Tal; Forest, Véronique-Isabelle; Hier, Michael P.; Mlynarek, Alex; McHugh, Tobial; Payne, Richard J.

doi:10.1177/0194599814556250

Cited by 44 publications

(51 citation statements)

References 19 publications

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“…Factors contributing to this may be more chances of fibrosis & compromised vascularity to parathyroid glands in a previously operated neck as well as unknown functional status of the parathyroid glands on the previously operated side. But this is in contrary to the findings of González-Botas and Piedrahita 42 and Merchavy et al, 43 who reported that postoperative hypocalcaemia was less common in patients with completion thyroidectomy than in patients who underwent total thyroidectomy. However, other authors like Godlewska P, et al reported incidence of hypoparathyroidism to be 15.74% following radical thyroid surgery versus 23.43% after completion thyroidectomy, supporting the data obtained in the current study.…”

Section: Discussioncontrasting

confidence: 76%

Factors Contributing to Post-Operative Hypocalcaemia After Total Thyroidectomyexperience in a Tertiary Care Govt. Hospital in Eastern India

Basak¹,

Choudhary²,

Roy³

et al. 2019

jemds

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BACKGROUND Postoperative hypocalcaemia is a common complication after total thyroidectomy but most often it is transient. Although these are mostly amenable to calcium and vitamin D supplementation, symptomatic patients sometimes need prolonged hospitalization following thyroid surgery, leading to increased healthcare costs. In the present study, we tried to find out factors which can predict the occurrence of post-operative hypocalcaemia & hypoparathyroidism in total thyroidectomy patients, facilitating their early detection and institution of definitive management in time, preventing emergency admissions & catastrophes. METHODS A prospective observational study was carried out in the Department of ENT & Head-Neck Surgery of a tertiary care govt. hospital in eastern India. Patients who underwent total thyroidectomy for multinodular goitre (MNG) and adenomatoid goitre (AG) or total/completion thyroidectomy for well differentiated thyroid carcinomas (WDTC), in the age group of 20-55 years were included in our study. We recorded the following parameters: Age, gender distribution of cases, type of operation, pre-operative Fine Needle Aspiration Cytology (FNAC) status, size of thyroid nodule operated (based on pre-operative ultrasonographic study), number of parathyroid glands preserved during operation, pre-operative vitamin D levels, post-operative serum calcium levels at 6 hours & 12 hours (positive i.e. increasing slope & non-positive i.e. decreasing/non-changing slope), early post-operative serum iPTH levels (at 6 hours), development of symptomatic hypocalcaemia-transient or permanent. RESULTS In the present study we measured serum calcium level 6 hours & 12 hours post-operatively. It has been found that patients with serum calcium levels on positive slope have lesser chances of occurrence of symptomatic hypocalcaemia & permanent hypocalcaemia than those on non-positive slope. We found that patients having serum iPTH level between 15-65 pg/ml showed lesser propensity to develop hypocalcaemia in comparison with those with serum iPTH level <15 pg/ml. In our study, it has been found that all the 3 cases who developed permanent hypocalcaemia were suffering from vitamin D deficiency; whereas, patients with normal vitamin D levels posed lesser risk of developing significant hypocalcaemia. In our observation, patients with only two parathyroid glands identified per-operatively have more chances of developing hypocalcaemia & those in whom all four parathyroid glands were preserved, very low risk of hypocalcaemia is associated. Furthermore, preservation of functional parathyroid gland with intact blood supply is found to be of immense importance than mere identification of the glands. In our series, it has been noted that with increase in the size of thyroid nodule, chances of hypocalcaemia increases. Patients undergoing complete thyroidectomy for histopathological report of WDTC in a previously benign (based on pre-operative FNAC) thyroid nodule, increased chances of development of post-operative hypocalcaemia. CONCLUSI...

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Section: Discussioncontrasting

confidence: 76%

Factors Contributing to Post-Operative Hypocalcaemia After Total Thyroidectomyexperience in a Tertiary Care Govt. Hospital in Eastern India

Basak¹,

Choudhary²,

Roy³

et al. 2019

jemds

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Section: Discussionmentioning

confidence: 99%

“…In our meta-analysis, only 2 of the included studies [5,9] mentioned central lymph node dissection as part of the surgical procedure. One of these 2 studies [9] did not consider the presence of lymph nodes in the surgical specimens, and the other one [5] found a similar incidence of hypocalcemia. Although our study cohort was short of these data, some authors indicated that central lymph node dissection was not a risk factor for postoperative hypocalcemia [21,22].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Completion Thyroidectomy and Primary Total Surgery for Differentiated Thyroid Cancer: A Meta-Analysis

Wang

et al. 2015

Oncol Res Treat

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Background: The aim of this study was to compare the complication rates between completion thyroidectomy and primary total thyroidectomy for differentiated thyroid cancer (DTC). Methods: PubMed, the Web of Knowledge, and the China Journal Net were searched for studies concerning the treatment of DTC published in 1990-2014. A meta-analysis was performed to compare the effects of different treatments. Results: 7 studies with a total of 1,208 patients were included. There were no statistically significant differences regarding the presence of temporary recurrent laryngeal nerve (RLN) palsy, permanent RLN palsy, temporary hypocalcemia, permanent hypocalcemia, hematoma, and wound infection. Conclusions: Completion thyroidectomy can be performed with acceptable morbidity in select cases of DTC who could not be properly diagnosed perioperatively or who recurred after less than total thyroidectomy.

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“…In comparison, the Freire et al pediatric thyroidectomy prospective longitudinal cohort study demonstrated similar transient hypocalcemia rates of 47% and symptomatic hypocalcemia rates of 15% [10]. In contrast, adult literature suggests transient hypocalcemia rates of 1.5-52% of cases [12][13][14]. This variability may be secondary to differences in defining hypocalcemia.…”

Section: Accepted Manuscript #12mentioning

confidence: 91%

“…One retrospective study on adults suggests transient hypocalcemia occurred in 1.5% of patients that underwent a completion thyroidectomy and 12.5% of patients that underwent a total thyroidectomy. There may be a significantly lower risk for hypocalcemia following a completion thyroidectomy compared to a total thyroidectomy [12]. Future studies should be performed in a larger pediatric cohort to determine whether patients undergoing completion thyroidectomy are equally at risk for developing postoperative hypocalcemia as those undergoing total thyroidectomy.…”

Section: Accepted Manuscript #12mentioning

confidence: 99%

A clinical pathway for the postoperative management of hypocalcemia after pediatric thyroidectomy reduces blood draws

Patel

Bly

Adams

et al. 2018

International Journal of Pediatric Otorhinolaryngology

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Comparison of the Incidence of Postoperative Hypocalcemia following Total Thyroidectomy vs Completion Thyroidectomy

Abstract: The risk of transient of hypocalcemia in patients undergoing CT is significantly lower than the rate of hypocalcemia in patients undergoing TT.

Cited by 44 publications

References 19 publications

Factors Contributing to Post-Operative Hypocalcaemia After Total Thyroidectomyexperience in a Tertiary Care Govt. Hospital in Eastern India

Factors Contributing to Post-Operative Hypocalcaemia After Total Thyroidectomyexperience in a Tertiary Care Govt. Hospital in Eastern India

Comparison of Completion Thyroidectomy and Primary Total Surgery for Differentiated Thyroid Cancer: A Meta-Analysis

A clinical pathway for the postoperative management of hypocalcemia after pediatric thyroidectomy reduces blood draws

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