Hypocalcemia After Thyroidectomy

Abstract

Serum calcium, sodium, potassium, chloride, magnesium, phosphorus, osmolarity, total protein, albumin, parathyroid hormone, and calcitonin values were systematically surveyed in 135 patients who underwent thyroidectomy and in 104 control surgical patients. A transient and moderate hypocalcemia developed after operation in thyroidectomized and control patients. Concentrations of other electrolytes, osmolarity, proteins, and albumin followed the same pattern of evolution. After thyroidectomy, the degree and duration of hypocalcemia increased with the extent of thyroid resection. A profound hypocalcemia (less than 2.0 mmol/L) and a marked reduction of the parathyroid hormone concentration (below normal) were present in 12% and 8% of cases after subtotal thyroidectomy and in 22% after total thyroidectomy. Calcitonin values did not increase after thyroidectomy. A slight correlation was observed between the preoperative serum alkaline phosphatase level and the minimal postoperative serum calcium level. It is concluded that post-thyroidectomy hypocalcemia is a multifactorial phenomenon. It is due, at least in part, to hemodilution. A temporary parathyroid insufficiency after subtotal and total thyroidectomy, and an avidity of the skeleton for calcium in hyperthyroid patients, may aggravate the hypocalcemia.

The Factors Related with Postoperative Complications in Benign Nodular Thyroid Surgery

“…It is noted that the degree and duration of hypoparathyroidism increase with the extent of thyroid surgery [24]. Ozbas and colleagues reported that the incidence of temporary hypoparathyroidism had increased with the extent of the surgery however, they also reported that extent of the surgery had no effect on permanent hypoparathyroidism [14].…”

Hypocalcemia – the most common complication after total thyroidectomy

“…The deterioration in the function of the parathyroid glands during surgery has a rapid effect on the serum parathyroid hormone concentration. (24,25) Early serum PTH assay is a promising method to distinguish early normocalcemic patients from hypocalcemic ones, considering that lower PTH levels have been shown to be signifi cantly correlated with patients developing postoperative hypocalcemia (3,4).…”

“…Patients must undergo close postoperative observation and laboratory evaluations. The reasons for postoperative hypoparatyroidism that leads to hypocalcemia are injury or devascularisation of a parathyroid gland, accidental removal of 1 or more parathyroid glands, hematoma formations (3,4,5,6). Hospital stay must be often extended due to this complication (7,8).…”

Hipocalcemia e hipoparatireoidismo clínico após tireoidectomia total

“…A sintomatologia é menos intensa ou ausente e, na maioria dos casos, desaparece em até 72 horas 23,25 . O hipoparatireoidismo transitório após tireoidectomias totais ocorre em até 87% dos casos e o permanente em até 33% [2][3][4][7][8][9][10][11][12][13]15,16,[26][27][28] . Neste estudo ocorreu em 37% dos casos no 1 o tipo e em 18% no 2 o , o que está de acordo com os dados de literatura.…”

“…Nos últimos 10 anos vários autores relataram taxas de hipocalcemia temporária entre 6 e 87% 2,3,4,[7][8][9][10][11][12][13] . A hipocalcemia permanente ocorre entre 0 e 33% nos casos de tireoidectomia total, a maioria assintomáticos 2,3,4,[7][8][9][10][11][12][13][14][15][16] . O diagnóstico pós-operatório é possível por meios clínicos e laboratoriais.…”