Hungry Bone Syndrome in thyrotoxicosis as a cause of postoperative hypocalcemia following total thyroidectomy - A prospective study.

Poongkodi, K (2014) Hungry Bone Syndrome in thyrotoxicosis as a cause of postoperative hypocalcemia following total thyroidectomy - A prospective study. Masters thesis, Madras Medical College, Chennai.


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Postoperative hypocalcemia, a well known complication of total thyroidectomy has a higher incidence in thyrotoxic patients than euthyroids. Though hypoparathyroidism is considered to be the important cause, other potential causes such as hungry bone syndrome (HBS) is not well established. Therefore we designed this prospective case control study to test the causal of hypothesis of hungry bone syndrome as a cause of postoperative hypocalcemia after total thyroidectomy among thyrotoxic patients. MATERIALS AND METHODS Forty clinically active hyperthyroid patients and 31 age and sex matched euthyoid patients were included in the study and control group respectively. Bone mineral density (BMD) at femur, lumbar vertebrae and forearm were measured initially at the time of diagnosis and six after total thyroidectomy in both groups. Baseline serum corrected calcium, phosphorus, magnesium, alkaline phosphatase and 25-OH VitaminD and serially thereafter in the postoperative period were measured in either group. The results were analysed with SPSS ver. 20 and p value <0.05 was considered significant. RESULTS: The mean age of hyperthyroid patients (M: F= 19:21) and euthyroid controls (M: F = 8:23) were 36.48+/-9.84 and 33.9+/-9.012 respectively. The incidence of postoperative hypocalcemia was higher among hyperthyroid cases at 82.5% as compared to 22.5% amongst euthyroid controls (Odd’s ratio=16.16, p<0.001). The incidence of HBS was 32.5% among thyrotoxic cases (Male: Female= 7:6) and constituted 39.5% of the cause for hypocalcemia. Transient hypoparathyroidism at71.4% constituted the major cause of hypocalcemia among euthyroid controls. Baseline BMD at femur, spine and forearm ( the values of which were 0.8512+/-0.1647 g/cm2, 0.9846+/-0.1676 g/cm2 and 0.643+/-0.1133 g/cm2) were significantly lower than euthyroid controls (which were 1.012+/-0128 g/cm2, 1.129+/- 0.115 g/cm2 and 0.751+/- 0.108 g/cm2, p<0.001). There was significant negative correlation between baseline femoral and lumbar BMD and serum alkaline phosphatase. Post treatment BMD revealed significant percent increment of 8.27% and 7.58% at femur and lumbar spine respectively. CONCLUSION: Post-thyroidectomy hypocalcemia was higher in thyrotoxic patient and HBS contributed to 39.5% of the cause whereas transient hypoparathyroidism was the major determinant among euthyroid controls. Elevated serum alkaline phosphatase and low preoperative magnesium (especially in young females) were the predictive risk factors among thyrotoxic and euthyroid controls respectively.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Hungry Bone Syndrome; thyrotoxicosis; postoperative hypocalcemia; total thyroidectomy; A prospective study.
Subjects: MEDICAL > Endocrine Surgery
Depositing User: Kambaraman B
Date Deposited: 23 Jun 2017 06:48
Last Modified: 23 Jun 2017 07:29

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