Protocol for management after thyroidectomy: a retrospective study based on one-center experience

Luo, Han; Yang, Hongliu; Wei, Tao; Gong, Yanping; Su, Anping; Ma, Yu; Zou, Xinyu; Lei, Jianyong; Zhao, Wanjun; Zhu, Jingqiang

doi:10.2147/tcrm.s129910

Cited by 9 publications

(10 citation statements)

References 19 publications

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“…On the other hand, relative parathyroid decline was proved to be a reliable predictor. In our previous preliminary study ( Luo et al, 2017 ), we found that relative 70% decline of PTH was a reasonable indicator of clinical hypocalcemia at 4.67% vs. 27.0% in patients with relative decline of ≤70% and >70%, respectively. Therefore, we hypothesized that PTH relative decline (RDP) may contribute to identifying high-risk patients of hypocalcemia who need calcitriol supplement after thyroidectomy.…”

Section: Introductionmentioning

confidence: 75%

A Prospective Study of Vitamin D Supplement in Thyroidectomy Patients Based on Relative Decline of Parathyroid Hormone

et al. 2021

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Background: In postthyroidectomy patients, hypocalcemia is the most common complication to prolong hospital stay and decrease patients’ satisfaction. Based on current evidence, it is recommended to supply vitamin D to patients with high risk of developing hypocalcemia. However, how to stratify the risk of patients remains challenging.Aim: We conducted a prospective study to evaluate the effect of vitamin D supplement (calcitriol) on high-risk hypocalcemia patients based on relative decline of parathyroid hormone (RDP).Method: RDP was calculated by the difference between preoperative and postoperative first-day PTH divided by preoperative PTH and presented as percentage. Patients who underwent total thyroidectomy in addition to bilateral central compartment dissection were enrolled prospectively and were divided into two cohorts: Cohort I: patients with RDP ≤70% and Cohort II: patients with RDP >70%. Patients in Cohort I were then randomly assigned to Group A or B, and patients in Cohort II were randomly assigned to Group C or D. All groups received oral calcium, and patients in Groups B and D also received calcitriol. All patients were followed for one year. In the study, standard procedure dictates that only oral calcium is given to patients whose RDP ≤70% and that oral calcium and calcitriol are given to patients whose RDP >70%. Therefore, Cohort I Group A and Cohort II Group D are controls in this study.Results: The incidence of clinical hypocalcemia in Groups A and D (the controls) was 11.0% (10/91), and 17.6% (16/91) required additional intravenous calcium. Of note, no patients developed permanent hypocalcemia. Furthermore, calcitriol supplement did not have significant impact on clinical outcomes between Group A and B in Cohort I. By contrast, calcitriol supplement distinctly improved clinical outcome by comparing Groups C and D (Cohort II), as marked by clinical hypocalcemia, need of requiring intravenous calcium, and long-termed decreased levels of PTH.Conclusion: Supplying calcitriol based on RDP cutoff of 70% may be a wise practice in thyroidectomy patients, and RDP 70% may be a useful predictor to stratify high-risk patients.

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Section: Introductionmentioning

confidence: 75%

A Prospective Study of Vitamin D Supplement in Thyroidectomy Patients Based on Relative Decline of Parathyroid Hormone

et al. 2021

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“…It can be transient or permanent secondary to hypoparathyroidism [23] . Transient hypocalcemia accounts for 10%-50% of thyroidectomies, and permanent hypocalcemia accounts for up to 2% of cases [24] . The incidence increased after total thyroidectomy, in which transient hypocalcemia occurs in 50%-68% of patients and permanent hypocalcemia occurs in 3% of patients [25] .…”

Section: Discussionmentioning

confidence: 99%

“…Regarding management, all patients with hypocalcemia are treated with calcium supplement orally; for those developing symptoms, an injection of 10% calcium gluconate 10-20 mL is given slowly 2 times a day, with oral administrations of calcium containing vitamin D 3 times a day [30] . If the decrease of postoperative calcium is <70%, the patients could be discharged in the first 24 h following operation, if it is > 70% the patients need longer hospitalization other than calcium supplement [24,31,32] .…”

Section: Discussionmentioning

confidence: 99%

Modified thyroidectomy: 4 techniques to prevent recurrent laryngeal nerve injury and postoperative hypocalcaemia

Salih

Baba²,

Ahmed

et al. 2022

IJS Short Reports

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Objective: To share 4 techniques that decrease the rate of postoperative hypocalcaemia and save recurrent laryngeal nerve with a good cosmetic outcome. Method:The research included all consecutive patients of thyroidectomy (hemi and total thyroidectomy) during 4-year practice. The techniques included (1) elevation of a circular flap after 4 cm collar incision. (2) Ligation of the pedicles (middle first-vein, inferior lastartery). ( 3) Sharp dissection of the parathyroid glands. (4) Sharp and blunt dissection and exposing the nerve in all of the patients. Result: The total numbers of patients were 2399. At least 1 symptom of hyperthyroidism was found in 1271 patients (53%). The main indication for operation was multinodular goiter and compression symptoms in 1331 (55.5%) patients, followed by thyrotoxicosis in 598 (25%) patients and malignancy in 402 (16.8%) patients. The most common operations were total thyroidectomy in 1880 (78.4%) patients, followed by thyroid lobectomy in 495 (20.6%) patients and completion thyroidectomy in 24 (1%) patients. Among all patients, 4 (0.16%) patients developed permanent voice change. Seven (0.3%) patients developed permanent hypocalcemia. Conclusion: This study offers a set of surgical techniques that reduced the risks of complications of thyroidectomy to a minimal range.

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“…Resection of the parathyroid tissue or damage the parathyroid glands during thyroidectomy may result in hypoparathyroidism, resulting in postoperative hypocalcaemia through mechanisms such as inhibition of bone resorption and reduction of 1,25‐dihydroxyvitamin D synthesis by the kidneys 1 . Acute hypocalcaemia impacts up to 50% of thyroidectomy patients and can be permanent in up to 2% of patients 2 . Patients with acute hypocalcaemia may experience symptoms ranging from mild (e.g., paraesthesia of the hands and feet) to severe (e.g., generalized seizures) tetany or they may be asymptomatic, which complicates postoperative management of hypocalcaemia.…”

Section: Introductionmentioning

confidence: 99%

“…1 Acute hypocalcaemia impacts up to 50% of thyroidectomy patients and can be permanent in up to 2% of patients. 2 Patients with acute hypocalcaemia may experience symptoms ranging from mild (e.g., paraesthesia of the hands and feet) to severe (e.g., generalized seizures) tetany or they may be asymptomatic, which complicates postoperative management of hypocalcaemia.…”

Section: Introductionmentioning

confidence: 99%

The use of vitamin D in preventing post‐thyroidectomy hypocalcemia: An endocrinologist survey study

Pinardo

Rubin

Hashemi

et al. 2020

Clinical Endocrinology

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Objective: To evaluate the use of preoperative vitamin D levels and postoperative vitamin D supplementation among endocrinologists for the prevention of post-thyroidectomy hypocalcaemia. Methods: Endocrinologist members of the American Thyroid Association (ATA) were contacted via email to complete a 21-question survey, which included both questions about demographic information, and preventing and managing postoperative hypocalcaemia after thyroidectomy. Univariate and multivariate analysis was performed to determine the respondents' use of preoperative vitamin D levels, dose and duration of preoperative vitamin D repletion, decision to delay surgery for low vitamin D levels in the case of a benign or malignant disease, and routine prescription of postoperative calcium or vitamin D supplementation. Results: 225 endocrinologists who were ATA members responded to the questionnaire. When compared to endocrinologists practicing in other countries, those that practice in the United States were 2.5 times more likely to check preoperative vitamin D levels (95% CI[1.404, 4.535], P = .002), significantly more likely to replete vitamin D deficient patients with high-dose vitamin D (ie ≥50K IU/week), 4.458 times more likely to prescribe prophylactic supplemental calcium (95% CI[2.446, 8.126]; P < .0001) and 3.48 more likely to prescribe supplemental vitamin D (95% CI [1.906, 6.355]; P < .0001). Endocrinologists who have been in practice for >10 years were also 1.915 times more likely to prescribe supplemental vitamin D (95% CI (1.080, 3.395); P = .0263). Physicians that treat >50 thyroidectomy cases/year were 2.083 more likely to recommend a vitamin D repletion duration of >1 month than those that treat ≤50 cases/year ([1.036, 4.190], P = .0395). Lastly, if the patient has low preoperative vitamin D levels, 47.05% of respondents chose to delay surgery in a benign disease, while only 11.61% of respondents would do so in a case of malignant disease. Conclusions: Approximately one-half of surveyed endocrinologists reported using preoperative vitamin D levels to assess a patient's risk for post-thyroidectomy | 599 PINARDO et Al.

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Protocol for management after thyroidectomy: a retrospective study based on one-center experience

Cited by 9 publications

References 19 publications

A Prospective Study of Vitamin D Supplement in Thyroidectomy Patients Based on Relative Decline of Parathyroid Hormone

A Prospective Study of Vitamin D Supplement in Thyroidectomy Patients Based on Relative Decline of Parathyroid Hormone

Modified thyroidectomy: 4 techniques to prevent recurrent laryngeal nerve injury and postoperative hypocalcaemia

The use of vitamin D in preventing post‐thyroidectomy hypocalcemia: An endocrinologist survey study

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