Incidence of transient & permanent Hypocalcaemia after Thyroid surgries, A Retrospective Study

DR SEHRISH SIDDIQUEPGT SURGICAL UNIT 1 BBH,RWP Incidence of Hypocalcemia after Thyroid Surgery:A retrospective studyDr 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: 04 to 42 %Permanent: 0 to 08%Int J Endocrinol Metab 2010; 1: 7-12 The occurrence of such complications has been attributed to 1:Pathology requiring thyroidectomy 2:Surgical techniques3:Reoperations 4:Neck dissection5:Experience of the surgical teamAIM & 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 opPost opAfter 24 hours After 1 week After 6 weeks

IDENTIFICATION OF PARATHYROIDS DURING THYROIDECTOMYRoutinely

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 Mean age 40.60 10.82 yearsMale to female ratio was 1:7.5Clinical PresentationFrequency % Neck mass 83Dysphagia 4.6Dyspnea 1.5Cervical lymphadenopathy 1.5Hyperthyroidism (controlled pre op) 05PATHOLOGY DiseaseTotal Pt(165)Simple Multinodular Goiter 113 with retrosternal extension 21Malignancy 17 Papillary Follicular Anaplastic 14 02 01Toxic Goiter 06Hashimoto thyroiditis 04Benign adenomas , follicular Nodules 04PATHOLOGYINCIDENCE OF HYPOCALCEMIAINCIDENCE OF HYPOCALCEMIATotal No of Patients Patients with hypocalcemia n (%) 165 33 (20%)PATIENTS DEVELOPING HYPOCALCEMIA Hypocalcemia Frequency%Laboratory hypocalcemia20 %Symptomatic hypocalcemia11.5 %Requiring I.V. Calcium 5.5 %INCIDENCE OF HYPOCALCEMIA ACCORDING TO DISEASE Disease Total no of patientsn=165Incidence of hypocalcemia n= 33 Frequency% Simple MNG (Euthyroid) 113 18 15%Retrosternal Goiter21 07 33%Malignancy 17 06 35%Thyrotoxicosis06 01 16%Hashimotos thyroiditis04 01 25%INCIDENCE OF HYPOCALCEMIA ACCORDING TO DISEASEINCIDENCE OF HYPOCALCEMIA ACCORDING TO TYPE OF THYROIDECTOMYSurgery Patients n=165Hypocalcemia n=33Hypocalcemia %Near total thyroidectomy 134 24 16 %Total thyroidectomy 10 03 30%Total thyroidectomy with neck dissection 17 06 35 %Unilateral thyroid lobectomy & isthmusectomy 04 0 0%INCIDENCE OF HYPOCALCEMIA ACCORDING TO TYPE OF THYROIDECTOMYINCIDENCE OF HYPOCALCEMIA ACCORDING TO TYPE OF THYROIDECTOMYPERMANENT HYPOCALCEMIAHypocalcemia persistent after 6 months can be labelled as permanent.

Total Patients with hypocalcemia 33/165

Patients with transient 31/33

Patients with permanent 2/33 Acta Otorhinolaryngol Ital. 2011 Jun; 31(3): 144148CONCLUSIONThyroid malignancy 35 % Total thyroidectomy 35% along with neck dissection

Retrosternal goiter 33 %In this study Incidence of hypocalcemia is 20 %.Higher in patients withCONCLUSIONOperation requiring greater tissue manipulation cause greater damage to parathyroid glands resulting into hypocalcemia.

Surgeons BE AWARE of it

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