Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection

Roh, Jong–Lyel; Park, Jae Yong; Park, Chan Il

doi:10.1002/cncr.24027

Cited by 145 publications

(129 citation statements)

References 22 publications

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“…This is because we followed a strategy of giving calcium and vitamin D in the first postoperative day aiming at reducing the risk of transient hypocalcemia without causing parathyroid hormone inhibition. 43 CLN metastasis is considered the most important risk factor for local recurrence. 44 Also it decreases survival and it is related to distant metastasis.…”

Section: Discussionmentioning

confidence: 99%

Papillary thyroid carcinoma, evaluation of prophylactic central compartment’s dissection versus conservative management: a prospective study

Ali

Abdelhameed

2018

Int Surg J

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INTRODUCTIONPTC is the most common well differentiated thyroid carcinoma (WDTC) and is considered a relatively indolent tumor.1 This relatively benign Behavior has led to a concept that CLND would not affect survival rates.2 Despite this, regional lymph node (LN) metastases are frequent in PTC occurring in 20% to 90% of patients. 3The pattern of LN metastasis takes place in a sequential manner; involving the central compartment (level VI) first with a frequency reaching 90% including micrometastases, followed by the ipsilateral lateral compartment and then the contralateral lateral compartment and the mediastinal LN. 4,5 Although there is consensus of block node dissection in node positive patients there is controversy about the benefits of elective CLND in N0 PTC. 6 Patients have a ABSTRACTBackground: Papillary thyroid carcinoma (PTC) is one of the commonest thyroid cancers. While there is consensus of block node dissection in nodal positive patients, there is controversy in dealing with nodal negative patients regarding the need of block node dissection. We aimed to evaluate prophylactic central lymph node dissection (pCLND) versus conservative management in PTC with N0 neck. Methods:This was a prospective randomized study conducted at General Surgery Department, Sohag University Hospital, from August 2013 to September 2017. It included fifty-five patients diagnosed to have PTC with N0 neck randomly divided into two groups; (Group A) included 25 patients who underwent total thyroidectomy (TT) alone and (Group B) included 30 patients who underwent TT with pCLND. We compared both groups regarding the operative and post-operative outcomes.Results: There was temporary hypoparathyroidism with an incidence of 12% for Group A and 23% for Group B (P=0.01). Permanent hypocalcemia occurred in 1 patient in each group (P=0.75). Unilateral recurrent laryngeal nerve (RLN) temporary palsy occurred in 10% for Group B patients and in 8% for Group A patients, (P=0.46). Node metastases were observed in 43% in group B upstaging the disease. Both univariate and multivariate analyses showed that CLN metastasis was significantly associated with age <45, male gender, tumor size >2.0cm, bilaterality, and multifocality. Locoregional recurrence was observed in 4% of patients in group A and in 0% in B.Conclusions: TT+pCLND is a safe treatment in patients with N0 PTC and it can be done without a high complication rate and without recurrence compared to TT without CLND.

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Section: Discussionmentioning

confidence: 99%

Papillary thyroid carcinoma, evaluation of prophylactic central compartment’s dissection versus conservative management: a prospective study

Ali

Abdelhameed

2018

Int Surg J

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“…First of all, the definition of hypocalcemic symptom is subjective and arbitrary, and many previous studies have used their own definitions (13,(24)(25)(26)(27)(28)(29). The result of this study may be biased by the threshold for pain or tingling sensation of the patients.…”

Section: Discussionmentioning

confidence: 99%

Percentage Decline of Parathyroid Hormone Level is a Predictor for Post-thyroidectomy Symptomatic Hypocalcemia

et al. 2017

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Purpose: Postoperative hypocalcemia is one of the most common complications after thyroid surgery. However, the predictive efficacy of parathyroid hormone (PTH) level was still controversial. We investigated the cut-off value of perioperative PTH level for postoperative hypocalcemia after total thyroidectomy. Methods: Four hundred eighty-two patients performed total thyroidectomy from January 2015 to December 2016 were enrolled. Demographics, operative variables and the development of symptomatic hypocalcemia were collected and evaluated. Results: Transient symptomatic hypocalcemia occurred in 83 (17.2%) patients and 5 (1.0%) patients have progressed to the permanent hypocalcemia. Patients with transient symptomatic hypocalcemia showed significantly lower postoperative day 1 PTH level than those without hypocalcemia (7.7±6.5 vs. 13.1±10.4 pg/mL; P<0.001), while correlation between postoperative PTH level and development of symptomatic hypocalcemia was not found in a multivariate analysis (P=0.122). Percentage decline of the preoperative PTH only showed significant association with transient hypocalcemia and the recommended cut-off value was 75.0%. When percentage decline of 75.0% was used, the incidence of transient hypoparathyroidism was 3.4 times (95% confidence interval, 2.1-5.6) higher in high percentage decline group (P<0.001). In regard to the permanent hypoparathyroidism, there were no significant differences in all factors. Conclusion: Percentage decline of PTH can be used as a predictive factor for postoperative hypocalcemia. Cautions against preventing injury of the parathyroid glands with careful surgical technique should be recommended.

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“…El uso de calcio oral preventivo en el posoperatorio ha demostrado disminuir la frecuencia de hipocalcemias sintomáticas 14 . En nuestra serie todos recibieron aporte preventivo de calcio y ninguna de las hipocalcemias desarrollo síntomas.…”

Section: Discussionunclassified

Experiencia clínica en tiroidectomía total

2011

Rev. Otorrinolaringol. Cir. Cabeza Cuello

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RESUMENIntroducción: La tiroidectomía total es una de las cirugías más frecuentes en cabeza y cuello. La experiencia en servicios de ORL es escasa en Chile.Objetivo: Analizar la experiencia clínica en tiroidectomía total en el Servicio de ORL del Hospital Guillermo Grant Benavente.Material y método: Estudio descriptivo prospectivo. Evaluación de los aspectos clínicos, la técnica quirúrgica y el porcentaje de complicaciones de los pacientes sometidos a tiroidectomía total durante el año 2009.Resultados: Se realizaron 34 tiroidectomías totales. La indicación más frecuente fue bocio multinodular (82,3%). Los diagnósticos más frecuentes fueron hiperplasia folicular (44%) y carcinoma papilar (32%). Se presentó lesión del nervio laríngeo recurrente transitoria en 8,8%, no se presentaron lesiones permanentes. Se presentó hipocalcemia transitoria en 29% y permanente en sólo un paciente (2,9%).Conclusiones: Nuestra experiencia presenta resultados en relación a indicaciones, diagnósticos y complicaciones concordantes con los estándares aceptados por la literatura mundial.Palabras clave: Tiroidectomía, total, complicaciones. ABSTRACT Introduction: Total thyroidectomy is one of the most frequent surgeries in head and neck. Experience in ENT services is scarce in Chile.Aim: To analyze clinical experience in total thyroidectomy in the ENT service of Guillermo Grant Benavente Hospital.Material and method: Prospective descriptive study. Evaluation of clinical aspects, surgical technique and percentage of complications of patients submitted to total thyroidectomy during the year 2009.Results: There were done 34 total thyroidectomies. The most frequent indication was multinodular goiter. The most frequent diagnoses were follicular hyperplasia (44%) and papillary carcinoma (32%). Transitory injury to the recurrent laryngeal nerve was present in 8,8%. Permanent injuries did not happen. Transitory hypocalcemia was present in 29% and permanent in only one patient (2,9%).Conclusions: Our experience presents results in relation to indications, diagnosis and complications, in accordance with the standards of the world literature.

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Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection

Abstract: BACKGROUND: Routine oral calcium and vitamin D supplementation may prevent hypocalcemic crisis, but its efficacy has not been studied in patients undergoing thyroidectomy plus central neck dissection (CND).

Cited by 145 publications

References 22 publications

Papillary thyroid carcinoma, evaluation of prophylactic central compartment’s dissection versus conservative management: a prospective study

Papillary thyroid carcinoma, evaluation of prophylactic central compartment’s dissection versus conservative management: a prospective study

Percentage Decline of Parathyroid Hormone Level is a Predictor for Post-thyroidectomy Symptomatic Hypocalcemia

Experiencia clínica en tiroidectomía total

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