Original Research Paper

Predictors Of Transient Hypocalcemia In Post Thyroidectomy Patients

Abstract :

BACKGROUND- Parathyroid dysfunction leading to symptomatic hypocalcemia is not uncommon following a total or subtotal thyroidectomy and is often associated patient morbidity and a prolonged hospital stay. This study aims to 1.To evaluate preponderance of transient hypocalcemia in post thyroidectomy patients and to see its relation with other variables2.To evaluate a predictor for the transient hypocalcemia in patients who haveundergone thyroidectomyMaterials and methods- This study was a prospective study which included all patients who underwent thyroidectomy with transient hypocalcemia, satisfying inclusion and exclusion criteria in Father Muller Medical College between November 2018 and October 2020.Results-30 patients were included in this study( 26 females and 4 males) all of whom developed transient hypocalcemia post thyroidectomy. The age group of the patients ranged from cases 23 years to 63 years with the highest number of cases being between the age group of 41-50 years(36.6%). 27 cases presented with multinodular goitre(90%) and 3 cases with solitary thyroid nodule(10%).22(73.7%) of patients had normal thyroid function tests pre-operatively,3 (10%) had hyperthyroidism and 5(16.67%) had hypothyroidism. Pre operative calcium levels were normal in 22 patients (73.3%) with only 8 patients having hypocalcemia(26.7%). 100 percent of patients had normal parathyroid levels pre operatively. 13 cases (43.33 %) had bilobed disease and 17 had unilateral lobe involvement (56.67%) and 3,3 % had evidence of retrosternal extension .The mean size of the gland was 15,76 (SQ CM), the smallest gland excised was 7.5 (SQ CM)and the largest was 24 (SQ CM) with mean duration of surgery being 186minutes. Post operatively 8 patients had hypocalcemia in 24 hours and 24 patients (80%0 developed the same in 48 hours. The lowest measured value of serumcalcium levels being 7.7 mg/ dl.24 hours post surgery, 9 patients had noral parathyroid levels( 30.00%) and 22 had hypoparathyroidism(70.00%) at 48 hours.The mean duration of hospital stay post operatively was 3.97 days, the longest being 6 days and the shortest being 2 days. The study showed a higher incidence of hypocalcemia in those who had a larger thyroid or features of thyroiditis or malignancy intraoperatively (P value less than 0.001) . We also noted that patients with abnormal thyroid levels preoperatively ( hyper or hypothroisism) had a higher chance of developing hypocalcemia (r=0.45 p=0.034 )post operatively.Conclusion: Hypocalcaemia is the most common problem in the post-operative period following the total thyroidectomy causing potentially severe symptoms and anxiety in affected patients and increasing hospitalization time.Transient hypocalcaemia ,often observed after the operation, generally responds favourably to replacement therapy within a few days or weeks. An anticipation and screening of patients pre operatively helps determine the risk factors for the development of hypocalcemia and helps us treat the patients earlier to decrease hospital stay.

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