Evaluation of Variables Impacting the Onset of Hypocalcemia After Thyroid Surgery: A Postoperative Perspective: Variables Impacting Hypocalcemia After Thyroid Surgery

Tariq Jamil; Javed Mirdad Tarar; Sanaullah Bhatti; Muhammad Maqsood Zahid; Amjad Ali; Akhtar Ali

doi:10.54393/pjhs.v5i07.1887

Authors

Tariq Jamil Department of General Surgery, Bakhtawar Amin Medical and Dental College, Multan, Pakistan
Javed Mirdad Tarar Department of Thoracic Surgery, Bakhtawar Amin Medical and Dental College, Multan, Pakistan
Sanaullah Bhatti Department of Ear, Nose and Throat, Bakhtawar Amin Medical and Dental College, Multan, Pakistan
Muhammad Maqsood Zahid Department of Surgery, Aziz Bhatti Shaheed Hospital, Gujrat, Pakistan
Amjad Ali Department of Anatomy, Bakhtawar Amin Medical and Dental College, Multan, Pakistan
Akhtar Ali Department of Surgery, Sialkot Medical College, Sialkot, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v5i07.1887

Keywords:

Thyroidectomy, Hypocalcemia, Hypoparathyroidism, Papillary Carcinoma, Retrosternal Goiter

Abstract

All across the globe, thyroidectomy is a common surgical procedure. After thyroid surgery, hypocalcaemia, which can be caused by either temporary or permanent hypoparathyroidism, is the most prevalent side effect. Objective: To quantify the frequency of hypocalcemia in individuals treated with thyroid surgery. Methods: In this descriptive study/ cross-sectional study, sixty-three cases were considered. The ages of the patients ranged from 18-60 years. Researchers checked patients' blood calcium levels both before surgery and on day one after the procedure. Those who underwent a complete thyroidectomy were checked for symptoms of low calcium levels. Utilizing SPSS version 24.0, the analysis was carried out. Results: There were more females than males among the 63 patients. In terms of tumour kind, papillary cancer, follicular cancer, and Hurthle cell carcinoma were the most prevalent. Hypocalcemia was detected in 18 instances (28.6% of the total). Thirteen females and five males constituted up the eighteen patients with hypocalcemia. In seven cases (38.9%), the retrosternal extension of goiter was detected, while in eleven cases (61.1%), no such extension was detected. Additionally, in every case, postoperative complications such as seroma, transient hoarseness of voice, or a hematoma in the neck were noted. Conclusions: Hypocalcemia was more common in 28.6% of patients following thyroid surgery, according to this research. Without retrosternal extension, the majority of the cases were female. All patients also experienced seroma, temporary hoarseness of voice, and neck hematoma in addition to hypocalcemia.

References

Falch C, Hornig J, Senne M, Braun M, Konigsrainer A, Kirschniak A et al. Factors predicting hypocalcemia after total thyroidectomy-A retrospective cohort analysis. International Journal of Surgery. 2018 Jul; 55: 46-50. doi: 10.1016/j.ijsu.2018.05.014. DOI: https://doi.org/10.1016/j.ijsu.2018.05.014

Mumtaz W, Rehman U, Mahmood A, Nauman F, Shaikh K, Saeed Z. Frequency of hypocalcaemia following total thyroidectomy. Pakistan Journal of Medical and Health Sciences. 2021 Sep; 15(9): 2863-6. doi: 10.53350/pjmhs211592863. DOI: https://doi.org/10.53350/pjmhs211592863

Tsai SD, Mostoufi-Moab S, Bauer S, Kazahaya K, Hawkes CP, Adzick NS et al. Clinical utility of intraoperative parathyroid hormone measurement in children and adolescents undergoing total thyroidectomy. Frontiers in Endocrinology. 2019 Nov; 10: 760. doi: 10.3389/fendo.2019.00760. DOI: https://doi.org/10.3389/fendo.2019.00760

Baloch N, Taj S, Anwer M, Naseem M. Frequency of hypocalcaemia following total thyroidectomy. Pakistan Journal of Medical Sciences. 2019 Jan; 35(1): 262. doi: 10.12669/pjms.35.1.93. DOI: https://doi.org/10.12669/pjms.35.1.93

Overman Jr RE, Hsieh LB, Menon R, Thomas IH, Bruch SW. 4-Hour postoperative PTH level predicts hypocalcemia after thyroidectomy in children. Journal of Pediatric Surgery. 2020 Jul; 55(7): 1265-9. doi: 10.1016/j.jpedsurg.2019.11.014. DOI: https://doi.org/10.1016/j.jpedsurg.2019.11.014

Sturniolo G, MG LS, Tonante A, D'Alia C, Bonanno L. Hypocalcemia and hypoparathyroidism after total thyroidectomy: a clinical biological study and surgical considerations. International Journal of Surgical Investigation. 2000 Jan; 2(2): 99-105.

Wang YH, Bhandari A, Yang F, Zhang W, Xue LJ, Liu HG et al. Risk factors for hypocalcemia and hypoparathyroidism following thyroidectomy: a retrospective Chinese population study. Cancer Management and Research. 2017 Nov: 627-35. doi: 10.2147/CMAR.S148090. DOI: https://doi.org/10.2147/CMAR.S148090

Khan A, Ali M, Syed A. Frequency of hypocalcemia in post thyroidectomy patients. Journal of Saidu Medical College, Swat. 2015; 5(1): 575-81. doi: 10.52206/jsmc.2015.5.1.575-581. DOI: https://doi.org/10.52206/jsmc.2015.5.1.575-581

Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G et al. STROCSS 2019 Guideline: strengthening the reporting of cohort studies in surgery. International Journal of Surgery. 2019 Dec; 72: 156-65. doi: 10.1016/j.ijsu.2019.11.002. DOI: https://doi.org/10.1016/j.ijsu.2019.11.002

Bai B, Chen Z, Chen W. Risk factors and outcomes of incidental parathyroidectomy in thyroidectomy: a systematic review and meta-analysis. PLOS One. 2018 Nov; 13(11): e0207088. doi: 10.1371/journal.pone.0207088. DOI: https://doi.org/10.1371/journal.pone.0207088

Pooria A, Pourya A, Gheini A. Frequency of pathological types of hyperthyroidism in thyroid scan patients. Current Medical Imaging. 2021 May; 17(5): 608-12. doi: 10.2174/1573405616666201118142752. DOI: https://doi.org/10.2174/1573405616666201118142752

Nicholson KJ, Teng CY, McCoy KL, Carty SE, Yip L. Completion thyroidectomy: A risky undertaking?. The American Journal of Surgery. 2019 Oct; 218(4): 695-9. doi: 10.1016/j.amjsurg.2019.07.014. DOI: https://doi.org/10.1016/j.amjsurg.2019.07.014

S.M. Jalali, M. Azadbakht, S. Azadbakht, S. Daniali, E. Farokhi.Prevalence of secondary hyperparathyroidism following bariatric surgery. International Journal of Surgery Open. 2020; 27(5): 214-219. doi: 10.1016/j.ijso.2020.11.022. DOI: https://doi.org/10.1016/j.ijso.2020.11.022

Aghsaiefard Z, Hossenifard Z, Alizadeh R, Ramim T. The relationship between hemoglobin level, PTH level, and dialysis adequacy in chronic hemodialysis patients. Tehran University Medical Journal. 2018 Apr; 76(4): 257-64.

Marzban‐Rad S, Sattari P, Heidarian Moghadam M, Azimi G. Early percutaneous dilational tracheostomy in COVID‐19 patients: a case report. Clinical Case Reports. 2021 Feb; 9(2): 1014-7. doi: 10.1002/ccr3.3632. DOI: https://doi.org/10.1002/ccr3.3632

Mehmood Z. Complications following completion thyroidectomy. Journal of Surgery Pakistan. 2019 Jul; 24(2): 67-70.

El Nemr S, Reda M, Hashish M, Amir H. Assessment of Hypocalcemia Following Total Thyroidectomy for Benign Thyroid Lesions: To Be Continued or Not?. The Egyptian Journal of Hospital Medicine. 2019 Apr; 75(1): 2105-11. doi: 10.21608/ejhm.2019.29725. DOI: https://doi.org/10.21608/ejhm.2019.29725

Peroni E, Angiolini MR, Vigone MC, Mari G, Chiumello G, Beretta E et al. Surgical management of pediatric Graves' disease: an effective definitive treatment. Pediatric Surgery International. 2012 Jun; 28: 609-14. doi: 10.1007/s00383-012-3095-5. DOI: https://doi.org/10.1007/s00383-012-3095-5

Zobel MJ, Long R, Gosnell J, Sosa JA, Padilla BE. Postoperative hypoparathyroidism after total thyroidectomy in children. Journal of Surgical Research. 2020 Aug; 252: 63-8. doi: 10.1016/j.jss.2020.02.018. DOI: https://doi.org/10.1016/j.jss.2020.02.018

Tolone S, Roberto R, del Genio G, Brusciano L, Parmeggiani D, Amoroso V et al. The impact of age and oral calcium and vitamin D supplements on postoperative hypocalcemia after total thyroidectomy. A Prospective Study. BioMed Central Surgery. 2013 Oct; 13: 1-6. doi: 10.1186/1471-2482-13-S2-S11. DOI: https://doi.org/10.1186/1471-2482-13-S2-S11

Baldassarre RL, Chang DC, Brumund KT, Bouvet M. Predictors of hypocalcemia after thyroidectomy: results from the nationwide inpatient sample. International Scholarly Research Notices. 2012 Jul; 2012(1): 838614. doi: 10.5402/2012/838614. DOI: https://doi.org/10.5402/2012/838614

Patricio Gac E, Patricio Cabané T, José Amat V. Incidence of hypocalcemia after total thyroidectomy. Revista Médica de Chile. 2007; 135: 5. doi: 10.4067/S0034-98872007000100004. DOI: https://doi.org/10.4067/S0034-98872007000100004

Van den Eynde F, Van Den Heede K, Brusselaers N, Van Slycke S. Thyroid surgery in the elderly: a surgical cohort. Langenbeck's Archives of Surgery. 2023 Jun; 408(1): 254. doi: 10.1007/s00423-023-02982-6. DOI: https://doi.org/10.1007/s00423-023-02982-6

Alhazmi RA, Alobaid AM, Althunayyan SM, Syed W, Al-Rawi MB. A cross-sectional assessment of knowledge, awareness of risk factors, and perceptions of thyroid disease (TD) among adults living in Saudi Arabia-A community based study. Frontiers in Public Health. 2022 Nov; 10: 1041745. doi: 10.3389/fpubh.2022.1041745. DOI: https://doi.org/10.3389/fpubh.2022.1041745

Alqahtani SM, Almussallam B, Alatawi AS, Alsuhaimi NA, Albalawi A, Albalawi NS et al. Post-thyroidectomy complications and risk factors in Tabuk, Saudi Arabia: a retrospective cohort study. Cureus. 2020 Oct; 12(10). doi: 10.7759/cureus.10852. DOI: https://doi.org/10.7759/cureus.10852

Emre FY, Doğan E, Keskinoğlu P, Durak MG, Sarıoğlu S, İkiz AÖ. Evaluation of Thyroidectomy Results Performed at a Tertiary Academic Center. Turkish Archives of Otorhinolaryngology. 2023 Sep; 61(3): 118. doi: 10.4274/tao.2023.2023-5-19. DOI: https://doi.org/10.4274/tao.2023.2023-5-19

Park YM, Kim JR, Oh KH, Cho JG, Baek SK, Kwon SY et al. Comparison of functional outcomes after total thyroidectomy and completion thyroidectomy: Hypoparathyroidism and postoperative complications. Auris Nasus Larynx. 2019 Feb; 46(1): 101-5. doi: 10.1016/j.anl.2018.03.009. DOI: https://doi.org/10.1016/j.anl.2018.03.009

Docimo G, Ruggiero R, Casalino G, Del Genio G, Docimo L, Tolone S. Risk factors for postoperative hypocalcemia. Updates in Surgery. 2017 Jun; 69: 255-60. doi: 10.1007/s13304-017-0452-x. DOI: https://doi.org/10.1007/s13304-017-0452-x

Aldhafar A, Alghareeb F, Alammar Z. Clinical Study of Post Thyroidectomy Hypocalcemia. Journal of Endocrine Surgery. 2023 Jun; 23(2): 40-6. doi: 10.16956/jes.2023.23.2.40. DOI: https://doi.org/10.16956/jes.2023.23.2.40

Eismontas V, Slepavicius A, Janusonis V, Zeromskas P, Beisa V, Strupas K et al. Predictors of postoperative hypocalcemia occurring after a total thyroidectomy: Results of prospective multicenter study. BioMed Central Surgery. 2018 Dec; 18: 1-2. doi: 10.1186/s12893-018-0387-2. DOI: https://doi.org/10.1186/s12893-018-0387-2

Garrahy A, Murphy MS, Sheahan P. Impact of postoperative magnesium levels on early hypocalcemia and permanent hypoparathyroidism after thyroidectomy. Head & Neck. 2016 Apr; 38(4): 613-9. doi: 10.1002/hed.23937. DOI: https://doi.org/10.1002/hed.23937

Del Rio P, Rossini M, Montana CM, Viani L, Pedrazzi G, Loderer T et al. Postoperative hypocalcemia: analysis of factors influencing early hypocalcemia development following thyroid surgery. BioMed Central Surgery. 2019 Apr; 18: 1-8. doi: 10.1186/s12893-019-0483-y. DOI: https://doi.org/10.1186/s12893-019-0483-y

Zaat AS, Derikx JP, Zwaveling-Soonawala N, van Trotsenburg AP, Mooij CF. Thyroidectomy in pediatric patients with Graves' disease: a systematic review of postoperative morbidity. European Thyroid Journal. 2021 Nov; 10(1): 39-51. doi: 10.1159/000511345. DOI: https://doi.org/10.1159/000511345

Basak B, Biswas KD, Choudhary A, Roy S, Ghosh SK. Factors contributing to post-operative hypocalcaemia after total thyroidectomy-experience in a tertiary care Govt. Hospital in Eastern India. Journal of Evolution of Medical and Dental Sciences. 2019 Jul; 8(26): 2090-6. doi: 10.14260/jemds/2019/460. DOI: https://doi.org/10.14260/jemds/2019/460

Azadbakht M, Emadi-Jamali SM, Azadbakht S. Hypocalcemia following total and subtotal thyroidectomy and associated factors. Annals of Medicine and Surgery. 2021 Jun; 66: 102417. doi: 10.1016/j.amsu.2021.102417. DOI: https://doi.org/10.1016/j.amsu.2021.102417