Incidence of Hypocalcaemia after Thyroid Surgery;A Clinical Audit

Dr Sehrish Siddique Resident Surgical Unit 1 BBH, RWP.

INTRODUCTION

Hypocalcaemia is a known complication after Thyroidectomy, requiring prompt diagnosis and proper treatment.

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

The occurrence of such complications has been attributed to

1: Pathology requiring thyroidectomy 2: Surgical techniques3: Reoperations 4: Neck dissection5: Experience of the surgical team

AIM & OBJECTIVES:

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

MATERIALS & METHODS:• Retrospective study of the 165 consecative

thyroidectomies from Jan 2013- Sep 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 larngeal nerve and parathyroids are identified and

preserved as standard procedure.• Branches and not the main trunk of inferior thyroid artery is ligated.

Intraoperative Identification

Sup PT

Inf PT

RLN

Routinely all patients undergoing thyroidectomies are observed for

Symptoms and signs of hypocalcemia.Documented and managed.

Demography

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

Clinical Presentation Frequency %

Neck mass 83Dysphagia 4.6Dyspnea 1.5Weight loss 1.5Cervical lymphadenopathy 1.5Hyperthyroidism (controlled pre op)

01

Pathology Disease Total Pt(165)

Simple Multinodular Goitre 113 with retrosternal extention 24Malignancy 17 Papillary Follicular Anaplastic

14 02 01

Toxic Goiter 01Hashimoto thyroiditis 02

Diffuse Goiter 05Benign adenomas , follicular Nodules 06

Pathology

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 I.V. 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 number %

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 TYPE OF

THYROIDECTOMY

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 TYPE OF THYROIDECTOMY

NTT20%

TT33%

TT WITH NECK DISSECTION44%

1.9 % HYPOCALCEMIA

NTT TT TT WITH NECK DISSECTION LOBECTOMY +ISTHNUSECTOMY

PERMANENT HYPOCALCEMIAHypocalcemia persistant after 6 weeks can be labelled as persistent

Total Patients 165

Patients with transient 31/165

Patients with permanent 2/165

CONCLUSIONIncidence of hypocalcemia found to be associated with

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

(44 %)• Retrosternal goiter (21 %)

conclusion• Requiring greater tissue manipulation and danger of injury to

parathyroid glands.

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