SIDDIQUE

DR SEHRISH

PGT SURGICAL UNIT 1

BBH,RWP

Incidence of Hypocalcemia
after Thyroid Surgery:
A retrospective study

Dr Sehrish Siddique
Resident Surgical Unit 1 BBH, RWP.

INTRODUCTION
Hypocalcemia is a most common known complication after thyroidectomy, requiring
prompt diagnosis and proper treatment.
Incidence being:
Transient:
Permanent:

04 to 42 %
0 to 08%

Int J Endocrinol Metab 2010; 1: 7-12

The occurrence of such complications has been attributed to

1:
2:
3:
4:
5:

Pathology requiring thyroidectomy

Surgical techniques
Reoperations
Neck dissection
Experience of the surgical team

AIM & OBJECTIVES:

The goal of this study is to evaluate the incidence and risk factors
contributing to hypocalcemia, in patients who have undergone
thyroidectomy.

MATERIALS & METHODS:

Retrospective study of the 165 consecutive thyroidectomies
from Jan 2013- May 2015.
Work up included:
Serum calcium levels of all patients
Pre op
Post op
After 24 hours
After 1 week
After 6 weeks

IDENTIFICATION OF
PARATHYROIDS DURING
THYROIDECTOMY
Routinely

Recurrent laryngeal nerve and

parathyroid are identified
and preserved as standard
procedure.
Branches and not the main
trunk of inferior thyroid
artery are ligated
individually.

Routinally all the patients undergoing thyroidectomies

are observed post operatively for
Symptoms and signs of hypocalcemia.
Documented and managed.

Demography

GENDER DISTRIBUTION
160
140

Mean age 40.60 10.82 years

120
100

Male to female ratio was 1:7.5

80
60
40
20
0

MALE

FEMALE

Clinical Presentation

Neck mass
Dysphagia
Dyspnea
Cervical lymphadenopathy
Hyperthyroidism (controlled pre op)

Frequen
cy
%
83
4.6
1.5
1.5
05

PATHOLOGY
Disease
Simple Multinodular Goiter
with retrosternal
extension
Malignancy

Total
Pt(165)
113
21
17

Papillary
Follicular
Anaplastic
Toxic Goiter
Hashimoto thyroiditis
Benign adenomas , follicular Nodules

14
02
01
06
04
04

PATHOLOGY

DIFFUSE GOITER; 4%
HASHIMOTO; 3%

MALIGNANCY; 10%

RETROSTERNAL; 15%

Frequency %

MNG; 68%

MNG

RETROSTERNAL

MALIGNANCY

HASHIMOTO

DIFFUSE GOITER

INCIDENCE OF
HYPOCALCEMIA

INCIDENCE OF HYPOCALCEMIA
Incidence of hypocalcemia

Total No of
Patients

165

Patients with
hypocalcemia
n
(%)
33
(20%)

Pt with hypocalcemis; 17%

total no of pts

PATIENTS DEVELOPING
HYPOCALCEMIA
Hypocalcemia

Frequency
%

Laboratory hypocalcemia 20 %
Symptomatic
hypocalcemia

11.5 %

Requiring I.V. Calcium

5.5 %

INCIDENCE OF
HYPOCALCEMIA
ACCORDING TO DISEASE

INCIDENCE OF HYPOCALCEMIA
ACCORDING TO DISEASE
Disease

Total no of
patients
n=165
113

Incidence of
hypocalcemi
a
n= 33
18

Frequenc
y
%

Simple MNG
(Euthyroid)
Retrosternal
Goiter
Malignancy

21
17

06

35%

Thyrotoxicosis

06

01

16%

Hashimotos

04

01

25%

07

15%
33%

% HYPOCAlCEMIA
MNG; 12%
Thyrotoxicosis; 20%

HASHIMOTO; 13%

RETROSTERNAL; 27%

MALIGNANCY; 28%

MNG

RETROSTERNAL

MALIGNANCY

HASHIMOTO

Thyrotoxicosis

INCIDENCE OF HYPOCALCEMIA
ACCORDING TO TYPE OF
THYROIDECTOMY

INCIDENCE OF HYPOCALCEMIA
ACCORDING TO TYPE OF
THYROIDECTOMY
Surgery
Patients Hypocalce Hypocalce
n=165
Near total
thyroidectomy
Total
thyroidectomy
Total
thyroidectomy
with neck
dissection

mia

mia
%
16 %

134

n=33
24

10

03

30%

17

06

35 %

INCIDENCE OF HYPOCALCEMIA ACCORDING TO

TYPE OF THYROIDECTOMY
% HYPOCALCEMIA
NTT; 25%

TT WITH NECK DISSECTION; 48%

TT; 27%

NTT

TT

TT WITH NECK DISSECTION

PERMANENT HYPOCALCEMIA
Hypocalcemia persistent after 6 months can be labelled
as permanent.
Hypocalcemia
35
30

Total Patients with hypocalcemia

33/165

25
20
15
10
5

Patients with transient

Patients with permanent

31/33

2/33
Acta Otorhinolaryngol Ital. 2011 Jun; 31(3): 144148

CONCLUSION
In this study Incidence of hypocalcemia is 20 %.
Higher in patients with
Thyroid malignancy

35 %

Total thyroidectomy
35%
along with neck dissection
Retrosternal goiter

33 %

CONCLUSION
Operation requiring greater tissue manipulation
cause greater damage to parathyroid glands
resulting into hypocalcemia.

Surgeons BE AWARE of it

Mess with me?

YOU ARE GONNA HAVE A

BAD TIME