Preservation of parathyroid gland during total thyroidectomy and its outcome
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20250788Keywords:
Hypocalcaemia, Parathyroid insufficiency, Total thyroidectomy, Serum calcium levelsAbstract
Background: Parathyroid insufficiency is a frequent complication of total thyroidectomy, often leading to hypocalcaemia, which can be transient or permanent. This condition arises from factors like disrupted blood supply, injury or accidental removal of parathyroid glands. Since parathyroid hormone (PTH) is essential for calcium regulation, this study investigated parathyroid preservation, the timing of tetany symptoms post-surgery and the incidence of hypocalcaemia tetany after thyroidectomy.
Methods: This cross-sectional observational study, conducted from January to December 2021 at the Department of Otolaryngology-Head & Neck Surgery, Combined Military Hospital, Dhaka, included 42 randomly selected patients who underwent thyroid surgery. Data were collected systematically using structured data sheets.
Results: Among the 42 patients, 18 (42.86%) developed hypocalcaemia 16.67% within 24 hours, 61.11% after 48 hours and 16.67% after 72 hours. Of these, 77.78% had asymptomatic hypocalcaemia, while 22.22% showed symptoms. Transient hypocalcaemia occurred in 38.10% and permanent hypocalcaemia in 4.76% of cases.
Conclusions: The study revealed a significant postoperative decrease in serum calcium levels, particularly within 48–72 hours, with a 42.86% incidence of hypocalcaemia. These findings align with reported rates in other studies.
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References
Song CM, Jung JH, Ji YB, Min HJ, Ahn YH, Tae K. Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy. World J of Surg Oncol. 2014;12(1):200. DOI: https://doi.org/10.1186/1477-7819-12-200
Shaha AR, Jaffe BM. Parathyroid preservation during thyroid surgery. American J Otolaryngol. 1998;19(2):113-7. DOI: https://doi.org/10.1016/S0196-0709(98)90106-5
Watkinson JC, Gilbert RW. Tumours of the thyroid and parathyroid gland. Stell and Maran’s Head and Neck Surgery and oncology, 5th ed. 2012: 459-80. DOI: https://doi.org/10.1201/b13389
Sinnatamby CS. Last’s anatomy, 12th ed. 2011.
Karamanakos SN, Markuo KB, Panagoppulos K, Karavias D, Vagianos CE, Scopa CD, et al. Complications and risk factors related to the extent of surgery in thyroidectomy-results from 2,043 procedures. Hormones. 2010;9:318–25. DOI: https://doi.org/10.14310/horm.2002.1283
Ho TW, Shaheen AA, Dixon E, Harvey A. Utilization of thyroidectomy for benign disease in the United States: a 15-year population-based study. Am J Surg. 2011;201:570–4. DOI: https://doi.org/10.1016/j.amjsurg.2010.12.006
Paolo Del Rio1*, Matteo Rossini1, Chiara Montana Montana1, Lorenzo Viani1, Giuseppe Pedrazzi2, Tommaso Loderer1 and Federico Cozzani1.Postoperative hypocalcemia: analysis of factors influencing early hypocalcemia development following thyroid surgery.Del Rio et al. BMC Surgery 2019, 18(Suppl 1):25 DOI: https://doi.org/10.1186/s12893-019-0483-y
Liu EH, Solorzano CC, Katznelson L, Vinik AI, Wong R, Randolph G. AACE/ACE disease state clinical review: diagnosis and management of midgut carcinoids. Endocrine Practice. 2015;21(5):534-45. DOI: https://doi.org/10.4158/EP14464.DSC
Schulte KM, Roher HD. Complications in thyroid surgery of benign thyroid disease. Acta Chirurgica Austriaca. 2001;33(4):164-72. DOI: https://doi.org/10.1046/j.1563-2563.2001.01156.x
Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg. 2004;28:271-6. DOI: https://doi.org/10.1007/s00268-003-6903-1
Pisanu A, Piu S, Cois A, Uccheddu A. Hypocalcemia following total thyroidectomy: early factors predicting long term outcome. G Chir 2005;26(4):131-4.
Araujo Filho VJ, Silva Filho GB, Brandao LG, Santos LR, Ferraz AR. The importance of ligation of inferior thyroid artery in parathyroid function after subtotal thyroidectomy. Rev Hosp Clin Fac Med Sao Paulo. 2000;55(4):113-20. DOI: https://doi.org/10.1590/S0041-87812000000400002
Kovacs L, Goth MI, Voros A, Hubina E, Szilagyi G, Szabolcs I. Changes of calcium level following thyroid surgery—reasons and clinical implications. Exp Clin Endocrinol Diabetes. 2000;108(5):364-8. DOI: https://doi.org/10.1055/s-2000-8130
Wilson RB, Erskin C, Crowe PJ. Hypomagnesemia and hypocalcaemia after thyroidectomy. World J Surg. 2000;24(6):722-6. DOI: https://doi.org/10.1007/s002689910116
Qari F. Estimation of ionized calcium levels after total thyroidectomy at King Abdul Aziz University Hospital. Kuwait Med J. 2005;37:169-72.
Abboud B, Sargi Z, Akham M, Sleilatry F. Risk factors for post thyroidectomy hypocalcaemia. J Am Coll Surg. 2002;195:456-67. DOI: https://doi.org/10.1016/S1072-7515(02)01310-8
Rix T E, Sinha P. Inadvertent parathyroid excision during thyroid surgery. Surgeon. 2006;4(6):339-42. DOI: https://doi.org/10.1016/S1479-666X(06)80108-3
Chia SH, Weisman RA, Piex D, Kelly C, Dilmann WH, Ochoff LA. Prospective study of perioperative factors predicting hypocalcaemia after thyroid and parathyroid surgery. Arch Otolaryngeal Head Neck. 2010;15:87-91.
Michie W, Duncan T, Hamer-Hodges DW. Mechanism of hypocalcaemia after thyroidectomy for thyrotoxicosis. Lancet 1971;2:508–13. DOI: https://doi.org/10.1016/S0140-6736(71)91122-6
Bailey BJ (ed.). Head and neck surgery, 3rd edn, vol. 2. Chapter 115. Philadelphia, PA: Lippincott Williams & Wilkins, 2001: 1410.
Shoback D. Clinical practice. Hypoparathyroidism. N Engl J Med. 2008;359:391-403. DOI: https://doi.org/10.1056/NEJMcp0803050
Asari R, Passler C, Kaczirek K, Scheuba C, Niederle B. Hypoparathyroidism after total thyroidectomy: a prospective study. Archives of Surg. 2008;143(2):132-7. DOI: https://doi.org/10.1001/archsurg.2007.55
Tartaglia F, Giuliani A, Sgueglia M, Biancari F, Juvonen T, Campana FP. Randomized study on oral administration of calcitriol to prevent symptomatic hypocalcemia after total thyroidectomy. The American J Surg. 2005;190(3):424-9. DOI: https://doi.org/10.1016/j.amjsurg.2005.04.017
Toniato A, Boschin IM, Piotto A, Pelizzo M, Sartori P. Thyroidectomy and parathyroid hormone: tracing hypocalcemia-prone patients. The American J of Surg. 2008;196(2):285-8. DOI: https://doi.org/10.1016/j.amjsurg.2007.06.036
Lee BJ, Wang SG, Lee JC, Son SM, Kim IJ, Kim YK. Level IIb lymph node metastasis in neck dissection for papillary thyroid carcinoma. Arch of Otolaryngol Head & Neck Surg. 2007;133(10):1028-30. DOI: https://doi.org/10.1001/archotol.133.10.1028
Sasson AR, Pingpank JF, Wetherington RW, Hanlon AL, Ridge JA. Incidental parathyroidectomy during thyroid surgery does not cause transient symptomatic hypocalcemia. Archives of otolaryngology–head & Neck Surg. 2001;127(3):304-8. DOI: https://doi.org/10.1001/archotol.127.3.304
Azmi L, Bahadır O, Alper C. Determination of risk factors causing hypocalcaemia after thyroid surgery. Asian J Surg. 2019;42:883-9. DOI: https://doi.org/10.1016/j.asjsur.2018.12.009
Glinoer D, Andry G, Chantrain G, Samil N. Clinical aspects of early and late hypocalcaemia afterthyroid surgery. Eur J Surg Oncol. 2000;26(6):571-7. DOI: https://doi.org/10.1053/ejso.2000.0949
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. BMC surgery. 2018;18:1-2. DOI: https://doi.org/10.1186/s12893-018-0387-2
Qari FA. Estimation of ionized calcium levels after thyroidectomy at King Abdul Aziz university hospital (Jeddah). Pak J Med Sci. 2004;20(4):325-30.
Mehanna HM, Jain A, Randeva H, Watkinson J, Shaha A. Postoperative hypocalcemia—the difference a definition makes. Head & Neck: J for the Sci and Spec of the Head and Neck. 2010;32(3):279-83. DOI: https://doi.org/10.1002/hed.21175