Incidence of Transient & Permanent Hypocalcaemia After Thyroid Surgery;

A Clinical Audit

Dr Sehrish Siddique (Resident) Surgical Unit 1 BBH, RWP.

INTRODUCTION

Hypocalcaemia after total thyroidectomy is a serious and dangerous complication, requiring prompt diagnosis and proper treatment.

• Transient: 9 to 50 %• Permanent: 0.5 to 13%

The occurrence of such complications has been attribute to

1: Diagnosis 2: Surgical techniques3: Reoperations 4: Neck dissection5: Experience of the surgical team

AIM & OBJECTIVES:

The goal of this study is to evaluate the incidence rate and risk factors of transient and permanent hypocalcaemia in patients, who had undergone thyroidectomies, both with or without radical neck dissections.

MATERIALS & METHODS:• Data of the one sixty five patients was used in the study

from 2013-2015. Work up included:

Serum ionized calcium levels of all patients

• Pre op• Post op

After 24 hours

After 1 week

After 6 weeks

Patients were studied from January 2014 till September 2015.

Symptoms and signs of hypocalcemia registered.

Intraoperative Identification

Sup PT

Inf PT

RLN

RESULTS

• Out of 165 patients forty three (26%) patients belonged from the Rawalpindi district,

• Majority of patients 122 (73%) coming from A.J.K. & Murree.

MALE FEMALE0

20

40

60

80

100

120

140

160

GENDER DISTRI-BUTION

Mean age 40.60± 10.82 years

Male to female ratio was 1:7.5

PRESENTING SIGNS AND SYMPTOMS

Clinical Presentation Frequency %

Neck mass 83Dysphagia 4.6Dyspnea 1.5Weight loss 1.5Cervical lymphadenopathy 1.5Hyperthyroidism 01

PREOPERATIVE DIAGNOSIS Disease Total Pt(165)

Simple Multinodular Goiter 113 MNG (retrosternal goiter) 24Malignancy 17 Papillary Follicular Anaplastic

14 02 01

Toxic Goiter 01Hashimoto thyroiditis 02

Diffuse Goiter 05Benign adenomas , follicular Nodules 06

PREOPERATIVE DIAGNOSIS

MNG68%

RETROSTERNAL15%

MALIGNANCY10%

HASHIMOTO3%

DIFFUSE GOITER4%

Frequency %

MNG RETROSTERNAL MALIGNANCY HASHIMOTO DIFFUSE GOITER

INCIDENCE OF HYPOCALCEMIA

Total No of Patients

Patients with hypocalcemia n (%)

165 33 (20%)

Pt with hypocalcemia, 20 %

Incidence of hypocalcemia

Pt with hypocalcemis

PATIENTS DEVELOPING HYPOCALCEMIA Hypocalcemia Frequency

%Laboratory hypocalcemia 20 %

Symptomatic hypocalcemia

11.5 %

Requiring IV Calcium 5.5 %

Lab20 %

symp-tomatic11.6 %

re-quired Iv Ca5.5 %

Hypocalcemia

Lab symptomatic required Iv Ca

INCIDENCE OF HYPOCALCEMIA

ACCORDING TO DISEASE

Disease Total no of patients

Incidence of hypocalcemia (n ) %

Simple MNG (Euthyroid) 113 18 (11%)

MNG with Retrosternal Goiter

24 07 (21%)

Malignancy 17 06 (25 %)

Hashimoto thyroiditis 05 01 (20 %)

Diffuse Goiter 06 01 (16%)

MNG11%

RETROSTERNAL21%

MALIGNANCY25%

HASHIMOTO20%

DIFFUSE GOITER16%% HYPOCAlCEMIA

MNG RETROSTERNAL MALIGNANCY HASHIMOTO DIFFUSE GOITER

INCIDENCE OF HYPOCALCEMIA ACCORDING TO SURGERY

Surgery Patients n Hypocalcemia %

Near total thyroidectomy 113 20 %

Total thyroidectomy 35 33%

Total thyroidectomy with neck dissection

17 44 %

Unilateral thyroid lobectomy & isthmusectomy

06 1%

INCIDENCE OF HYPOCALCEMIA ACCORDING TO SURGERY

NTT20%

TT33%

TT WITH NECK DISSECTION44%

0.019 % HYPOCALCEMIA

NTT TT TT WITH NECK DISSECTION LOBECTOMY +ISTHNUSECTOMY

Hospital stay was significantly longer in hypocalcemic patients. (4 ± 1 days, range 2-5 days) than others (2 ± 0.5 days, range 1-3 days) (P < 0.001).

In female patients, the ratio of postoperative hypocalcemia was found to be significantly higher when compared to male patients (16% vs 4%, P<0.01).

CONCLUSIONIncidence of transient hypocalcemia found to be associated with

Requiring greater tissue manipulation and danger of injury to parathyroid glands.

• Thyroid malignancy (25 %)• Total thyroidectomy along with neck dissection

(44 %)• Retrosternal goiter (21 %)

• Permanent hypocalcemia is very rare & observed only in 2 patients requiring long term calcium & Vit D supplements.