Incidence of post-thyroidectomy hypocalcemia at the Clinicas Hospital
DOI:
https://doi.org/10.29193/RMU.36.3.6Keywords:
HYPOCALCEMIA, THYROIDECTOMY, HYPOPARATHYROIDISM, CALCIUMAbstract
Introduction: hypocalcemia is the most frequent complication in patients undergoing thyroidectomy.
Objective: to learn about the incidence of hypocalcemia during the first 72-hour period after surgery and
permanent hypoparathyroidism, as a complication of thyroidectomy in 6 years.
Methods: descriptive and retrospective study of patients undergoing thyroidectomy between January 2011 and December 2016. Hypocalcemia is defined as total serum calcium concentration < 8.8 mg/dL
Variables considered cwere gender, age, type and duration of surgery, clinical manifestations of acute
hypocalcemia and pathological anatomy, and they were crossed with the minimum measurement of calcemia. Permanent hypoparathyroidism was defined when patients were still under therapy at least one year after the surgery.
Results: 141 patients, 130 women, average age was 45.9 years old. 95% of them presented hypocalcemia
within the first 72 hours of the postoperative period; as to age and gender: =29 years old, 90% (p 0.38), 30 – 49, 96% (p 0.4), 50 – 69, 98% (p 0.52) and =70 92% (p 0.16); 97% of women and 91% of men (p 0.26) suffered from hypocalcemia. Duration of surgery: < 130 minutes, 130 – 185, _185, hypocalcemia was seen in 4, 2 and 1 patients respectively. Malignant lesions were found in 60 patients, 58 had hypocalcemia; out of 81 benign cases, 76 had hypocalcemia (p 0,537). In a group of thyroidectomies, 95% had hypocalcemia (p<0.05). 71% were asymptomatic hypocalcemia, 10% presented symptoms and there was no data for 19%. Eight of them have permanent hypoparathyroidism and there was no data for 11 cases.
Conclusions: most patients presented hypocalcemia. There was no correlation between hypocalcemia
and age, gender, duration of surgery or pathology results. Correlation was found between hyroidectomies
and hypocalcemia. One out of ten presented symptoms of hypocalcemia. Incidence of permanent hypoparathyroidism was 6%.
References
(2) Higgins C. Ionized calcium. Denmark: Radiometel Medical Aps, 2007-2018. Disponible en: https://acutecaretesting.org/-/media/acutecaretesting/files/pdf/ionized-calcium.pdf [Consulta: 24 setiembre 2018].
(3) Bártoli J.Hipocalcemia post-tiroidectomía total (determinación de la frecuencia). Bs. As.: Universidad Nacional de la Plata, 2007. [Tesis de doctorado].
(4) Herranz J, Lourido D. Hipocalcemia postiroidectomía total: incidencia, control y tratamiento. Acta Otorrinolaringol Esp 2013; 64(2):102-7.
(5) Méndez A, Chagcha L. Prevalencia de hipocalcemia postquirúrgica y manifestaciones clínicas neuromusculares en pacientes sometidos a tiroidectomía total en el Hospital Teodoro Maldonado Carbo desde el 1 de octubre del 2015 al 31 de marzo del 2016. Guayaquil: Universidad Católica de Santiago de Guayaquil, 2016:54 p. [Trabajo de titulación previo a la obtención del grado de médico].
(6) Abate EG, Clarke BL. Review of hypoparathyroidism. Front Endocrinol (Lausanne) 2017; 7:172.
(7) Lorente L, Sancho J, Muñoz L, Sánchez P, Sitges A. Defining the syndromes of parathyroid failure after total thyroidectomy. Gland Surg 2015; 82-90.
(8) Barquero H, DelgadoM, Juantá J. Hipocalcemia e hipoparatiroidismo post-tiroidectomía. Acta méd costarric 2015; 57(4):184-9. Disponible en: http://www.redalyc.org/articulo.oa?id=43442281004 [Consulta: 16 febrero 2018].
(9) SchaferAL, Shoback DM. Hypocalcemia: diagnosis and treatment. En: Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A, et al. Endotext. South Dartmouth (MA): MDText.com, 2000. Disponible en: http://www.ncbi.nlm.nih.gov/books/NBK279022/ [Consulta: 24 setiembre 2018].
(10) Jian-Biao Wang JB, Sun HL, Song CY, Gao L. Association between decreased serum parathyroid hormone after total thyroidectomy and persistent hypoparathyroidism. Med Sci Monit 2015; 21:1223-31.
(11) SousaA, Porcaro J, Soares J, Moraes G, Carvalho J, Savassi P. Predictors factors for post-thyroidectomy hypocalcaemia. Rev Col Bras Cir 2012; 39(6):476-82.
(12) DedivitisR, Pfuetzenreiter E, Nardi C, MolinariC, Barbara E. Prospective study of clinical and laboratorial hypocalcemia after thyroid surgery.Braz J Otorhinolaryngol 2010; 76(1):71-7.
(13) Ritter K, Elfenbein B, Schneider D, Chen H, Sippel R. Hypoparathyroidism after total thyroidectomy: incidence and resolution. J Sur Res 2015; 197(2):348-53.
(14) Seo ST, Chang JW, Jin J, Lim YC, Rha KS, Koo BS. Transient and permanent hypocalcemia after total thyroidectomy: early predictive factors and long-term follow-up results. Surgery 2015; 158(6):1492-9. doi: 10.1016/j.surg.2015.04.041
(15) EismontasV, Slepavicius A, Janusonis V, Zeromskas P, Beisa V, Strupas K, et al. Predictors of postoperative hypocalce mia occurring after a total thyroidectomy: results of prospective multicenter study. BMC Surg 2018; 18(1):55. doi:10.1186/s12893-018-0387-2
(16) Cho JN, Park WS, Min SY. Predictors and risk factors of hypoparathyroidism after total thyroidectomy. Int J Surg 2016; 34:47-52. doi: 10.1016/j.ijsu.2016.08.019.
(17) Vargas P, Montes J. Comportamiento del calcio sérico posterior a tiroidectomía total. Rev Escuela Med “Dr. José Sierra Flores” 2012; 26: 16-22.
(18) Chadwick D. Hypocalcaemia and permanent hypoparathyroidism after total/bilateral thyroidectomy in the BAETS Registry. Gland Surg 2017; 6(Suppl1):S69-S7. doi: 10.21037/gs.2017.09.14.
(19) Báez D. Comportamiento clínico y seguimiento en consulta externa de pacientes intervenidos de tiroidectomía en el Servicio de Cirugía del Hospital Alemán Nicaragüense de la ciudad de Managua en el período de enero 2014 a diciembre 2016. Universidad Nacional Autónoma de Nicaragua 2017; 1-97. [Protocolo de tesis para optar al título de Especialista en Cirugía].
(20) Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg 2014; 101(4):307-20.
(21) Pardo L, Sánchez P. Factores perioperatorios relacionados con la hipocalcemia postiroidectomía total. Rev Faso 2018; 25(2):1-4.
(22) WangW, Xia F,Meng C, Zhang Z, Bai,N, LiX. Prediction of permanent hypoparathyroidism by parathyroid hormone and serum calcium 24?h after thyroidectomy. Am J Otolaryngol 2018; 39(6):746-50. doi: 10.1016/j.amjoto.2018.08.005.
(23) PuzzielloA,RosatoL, InnaroN, OrlandoG,AveniaN, Perigli G, et al. Hypocalcemia following thyroid surgery: incidence and risk factors. A longitudinal multicenter study comprising 2,631 patients. Endocrine 2014; 47(2):537-42. doi: 10.1007/s12020-014-0209-y.
(24) González G, Argudo A. Frecuencia de hipocalcemia pos tiroidectomía total en pacientes de Solca, en la ciudad de cuenca 2000-2016. Universidad de Cuenca, 2017. [Proyecto de investigación previa a la obtención del Título de Médico].
(25) Abboud B, Sargi Z, Akkam M, Sleilaty F. Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg 2002; 195(4):456-61.
(26) Nawrot I, Pragacz A, Pragacz K, Grzesiuk W, Barczynski M. Total thyroidectomy is associated with increased prevalence of permanent hypoparathyroidism. Med Sci Monit 2014; 20:1675-81. doi: 10.12659/MSM.890988.
(27) Ambe P, Brömling S, Knoefel W, Rehders A. Prolonged duration of surgery is not a risk factor for postoperative complications in patients undergoing total thyroidectomy: a single center experience in 305 patients. Patient Saf Surg 2014; 8(1):45.
(28) Lang BH, Yih PC, Ng KK. Prospective evaluation of quick intraoperative parathyroid hormone assay at the time of skin closure in predicting clinically relevant hypocalcemia after thyroidectomy. World J Surg 2012; 36(6):1300-6. doi: 10.1007/s00268-012-1561-9
(29) Rosato L, Avenia N, Bernate P,De Palma M, GulinoG,Nasi P, 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.
(30) Coimbra C, Monteiro F, Oliveira P, Ribeiro L Almeida M, Condé A. Hypoparathyroidism following thyroidectomy: predictive factors. Acta Otorrinolaringol Esp 2017; 68(2):106-11.