Post-thyroidectomy permanent hypocalcemia and hypoparathyroidism: frequency and risk factors.

Muftah S. Elsaeiti, Khaled D. Alsaeiti


Background: Hypoparathyroidism is the most common complication after thyroidectomy and the main reason for frequent outpatients' visits; however, there is a poor understanding of its outcomes, and no clear follow-up strategies are available. We aimed to evaluate the frequency and risk factors of post-thyroidectomy hypocalcemia hypoparathyroidism in Libyan patients.

 Methods: A case series study was conducted. The serum calcium and parathyroid hormone level (PTH) were measured at least 8 months post thyroidectomy.

 Results: 124 patients were reviewed in this study; 19 (15.3 %) were males and 105 (84.7 %) were females. 30.6 % of males and 13.7% of females developed hypocalcemia and hypoparathyroidism. Total thyroidectomy (TT) was performed in 62.9 % of all patients, while 24.2% of all patients underwent near total thyroidectomy (NTT). 12.1% of all patients underwent bilateral subtotal thyroidectomy (BST) and 1 patient underwent hemi thyroidectomy (0.8%). The risk of hypocalcemia was higher in patients with malignant thyroid disease in comparison to benign thyroids (45.8 % vs. 27% of patients). Papillary thyroid carcinoma (PTC) was the most common cause of both hypocalcemia and hypoparathyroidism (45.5% for both) followed by Graves' disease (22.2% and 14.8% for hypocalcemia and hypoparathyroidism respectively). Hypocalcemia and hypoparathyroidism were more frequent in patients who underwent TT (19.2%), as compared to patients who underwent NTT (6.6 %). Among nine patients who were operated on twice, three patients had hypocalcemia, and two of them were found to be hypoparathyroid; one case is diagnosed with Graves' disease, while the other was diagnosed as PTC.

 Conclusion: Total thyroidectomy, and re-operation are associated with increased prevalence of permanent hypocalcemia and hypoparathyroidism when compared to less extensive thyroid resection modes. 

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Bhattacharyya N, Fried MP. Assessment of the morbidity and complications of total thyroidectomy. Archives of Otolaryngology–Head & Neck Surgery. 2002;128(4):389-92.

Al-Dhahri SF, Al-Ghonaim YA, Terkawi AS. Accuracy of postthyroidectomy parathyroid hormone and corrected calcium levels as early predictors of clinical hypocalcemia. Journal of Otolaryngol Head Neck Surgery. 2010;39:342-8.

Al-Dhahri SF, Mubasher M, Mufarji K, Allam OS, Terkawi AS. Factors predicting post-thyroidectomy hypoparathyroidism recovery. World Journal of Surgery. 2014;38(9):2304-10.

Falk SA, Birken EA, Baran DT. Temporary postthyroidectomy hypocalcemia. Archives of Otolaryngology–Head & Neck Surgery. 1988;114(2):168-74.

Pfleiderer A, Ahmad N, Draper M, Vrotsou K, Smith W. The timing of calcium measurements in helping to predict temporary and permanent hypocalcaemia in patients having completion and total thyroidectomies. The Annals of The Royal College of Surgeons of England. 2009;91(2):140-6.

Yip J, Lang BH-H, Lo C-Y. Changing trend in surgical indication and management for Graves' disease. The American Journal of Surgery. 2012;203(2):162-7.

Costanzo M, Marziani A, Condorelli F, Migliore M, Cannizzaro MA. Post-thyroidectomy hypocalcemic syndrome: predictive value of early PTH. Ann Ital Chir. 2010;81(4):301.

Testini M, Gurrado A, Lissidini G, Nacchiero M. Hypoparathyroidism after total thyroidectomy. Minerva chirurgica. 2007;62(5):409-15.

Chadwick D, Kinsman R, Walton P. Systems DC. The British Association of Endocrine and Thyroid Surgeon fourth national audit Henley-on-Thames: Dendrite Clinical Systems Ltd. 2012.

El-Shinawi M, El-Anwar A, Nada M, Youssef T, Fakhry E, Raslan S, et al. Oral calcium and vitamin D supplementation after total thyroidectomy. Thyroid Research and Practice. 2014;11(3):98.

Stavrakis AI, Ituarte PH, Ko CY, Yeh MW. Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery. Surgery. 2007;142(6):887-99.

Pieracci FM, Fahey III TJ. Effect of hospital volume of thyroidectomies on outcomes following substernal thyroidectomy. World Journal of Surgery. 2008;32(5):740-6.

Toniato A, Boschin IM, Piotto A, Pelizzo MR, Guolo A, Foletto M, et al. Complications in thyroid surgery for carcinoma: one institution’s surgical experience. World Journal of Surgery. 2008;32(4):572-5.

Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian S. Systematic review and meta‐analysis of predictors of post‐thyroidectomy hypocalcaemia. British Journal of Surgery. 2014;101(4):307-20.

Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery. 2003;133(2):180-5.

Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World Journal of Surgery. 2000;24(11):1335-41.

Hallgrimsson P, Nordenström E, Bergenfelz A, Almquist M. Hypocalcaemia after total thyroidectomy for Graves' disease and for benign atoxic multinodular goitre. Langenbeck's Archives of Surgery. 2012;397(7):1133-7.

Erbil Y, Bozbora A, Özbey N, İşsever H, Aral F, Özarmağan S, et al. Predictive value of age and serum parathormone and vitamin D3 levels for postoperative hypocalcemia after total thyroidectomy for nontoxic multinodular goiter. Archives of Surgery. 2007;142(12):1182-7.

Witte J, Goretzki PE, Dotzenrath C, Simon D, Felis P, Neubauer M, et al. Surgery for Graves' disease: total versus subtotal thyroidectomy—results of a prospective randomized trial. World Journal of Surgery. 2000;24(11):1303-11.

Songun I, Kievit J, Wobbes T, Peerdeman A, van de Velde CJ. Extent of thyroidectomy in nodular thyroid disease. European Journal of Surgery. 1999;165(9):839-42.

Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau J-L, et al. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World Journal of Surgery. 1998;22(7):718-24.

Youssef T, Gaballah G, Abd-Elaal E, El-Dosoky E. Assessment of risk factors of incidental parathyroidectomy during thyroid surgery: a prospective study. International Journal of Surgery. 2010;8(3):207-11.

Pappalardo G, Guadalaxara A, Frattaroli FM, Illomei G, Falaschi P. Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. European Journal of Surgery. 1998;164(7):501-6.


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