Clinical Study of Hypocalcemia following Thyroid Surgery

Muthukumaraswamy, P (2008) Clinical Study of Hypocalcemia following Thyroid Surgery. Masters thesis, Tirunelveli Medical College, Tirunelveli.

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Abstract

NEED FOR STUDY: Post-thyroidectomy hypocalcemia is a serious early complication. Estimates indicate that transient hypocalcemia incidence of 9.2% and permanent hypocalcemia incidence of 0.5%. Hypocalcemia may occur secondarily to surgical trauma, devascularization, unintentional removal of parathyroid glands, reoperation2. Even after meticulously performed procedures, some temporary parathyroid dysfunction may occur2. Surgery extension has been seen as a risk factor, as in total thyroidectomy there is potential blood supply involvement resulting from bilateral surgical manipulation. However, other factors are related to the chosen surgical procedure and its impact on devascularization or accidental removal of the parathyroid glands. The recommended surgical strategy is meticulous dissection and preservation of the parathyroid glands and their blood supply. The best way to avoid accidental excision is properly identifying the parathyroid glands. Risk of complication is higher when fewer than three glands are identified during surgery. Depending upon the extent of parathyroid damage, postoperative hypocalcemia may be transient, resolving within a few months, or permanent, requiring lifelong oral or intravenous calcium supplementation3. This study aims to prospectively study and analyze the incidence and possible causes of hypocalcemia following thyroid surgery. REVIEW OF LITERATURE: Postoperative hypocalcemia ia a common complication after thyroidectomy. permanent hypocalcemia is rare, The incidence of transient and permanent hypocalcemia was 9.2%, and 0.5%, respectively. Yon seon kim et al concluded in their study that the number of preserved parathyroid glands is the most important factor for predicting permanent hypocalcemia and found that only one functional parathyroid gland was needed to avoid permanent hypocalcemia. Even if all the parathyroid glands cannot be completely accounted for, the surgeon should make an attempt at identifying and preserving parathyroid glands without damaging their blood supply. Rogerio aparecido dedivitis et al recommended that parathyroid glands are spared based on careful dissection of the gland’s blood pedicle. Permanent hypoparathyroidism occurs exclusively when fewer than three parathyroid glands are identified during surgery. Other authors consider that the iden-tification and sparing of at least two glands may result in higher rates of permanent hypoparathyroidism. Randall L. Baldassarre et al concluded in their study that Postoperative hypocalcemiaoccurred in 5.5% (n = 6, 605) of all thyroidectomy patients before discharge. Patients undergoing total thyroidectomy had a postoperative hypocalcemia incidence of 9.0%, compared with 1.9% following unilateral thyroid lobectomy. OBJECTIVES OF THE STUDY: 1. To determine the incidence of hypocalcemia following thyroid surgery. 2. To study the prevalence of post thyroidectomy hypocalcemia in response to age 3. To study the various clinical presentations of post thyroidectomy hypocalcemia 4. Post thyroidectomy hypocalcemia related with various pathological conditions of thyroid 5. To correlate the serum calcium level with clinical diagnosis 6. To study the time of presentation of post thyroidectomy hypocalcemia 7. Post thyroidectomy related with surgical procedure SOURCE OF DATA : All patients undergoing thyroidectomy surgeries (Minimum of 50 cases) from August 2014 to July 2015 at Tirunelveli Medical College Hospital,Tirunelveli. METHODS OF COLLECTION OF DATA: Data will be collected from the patients undergoing total thyroidectomies by meticulous history taking, careful clinical examination, appropriate radiological, haematological investigations including serum calcium and serum albumin, operative findings and follow-up of the cases will be done after surgery for post-operative hypocalcemia. A. Sample: Minimum of 50 cases B. Study Design: Prospective study C. Statistical Method : Data collected will be analyzed using descriptive statistical principles (like mean, proportions and percentages) D. Inclusion Criteria : Patient aged more than 12 yrs including both genter with clinically and pathologically diagnosed thyroid swellings undergoing thyroidectomy surgery E. Exclusion Criteria : 1. Patients undergoing hemithyroidectomy/lobectomy. 2. Primary parathyroid pathologies. 3. Age < 12 years. 4. previous irradiation to neck 5. patient already on calcium supplementation. Does the study require any investigation or intervention to be conducted on patients or animals specify? No investigations will be done on animals. Study will be done on patients after taking their informed consent. Investigations: Investigations only on patients with their consent. 1. Routine blood investigations like hemoglobin, bleeding time, clotting time 2. Blood sugar levels 3. Renal parameters : Blood urea, Serum creatinine 4. Serum electrolytes including total Calcium and ionised Calcium (pre-operative and post-operative) 5. Serum Albumin 6. Liver function tests 7. Thyroid function tests: T3, T4, TSH, free T3 & T4. 8. Neck radiograph 9. Chest radiograph 10. FNAC 11. post operative histo pathological analysis. CONCLUSION: From our study we concluded that post thyroidectomy transient hypocalcaemia is a frequent complication which can be prevented with preoperative preparation of patients with extreme caution and peroperative meticulous dissection, prompt identification of parathyroids and postoperative frequent monitoring of serum calcium and early treatment can prevent significant morbidity. Parathyroid autotransplantation should be considered in accidental injury to parathyroids during the procedure. Resurgeries of thyroid should be done with extreme caution. For treating patients more than 50 years surgeon should careful in preventing hypocalcaemia. While doing surgeries for malignant and toxic lesions for thyroid, the surgeon should consider total thyroidectomy as not only a thyroid removing surgery but also a surgery done to preserve parathyroids. For small scale hospitals serial monitoring of serum calcium levels preoperatively and postoperatively combined with careful monitoring of signs. and symptoms of hypocalcemia is a efficient and cost effective tool to detect post thyroidectomy hypocalcemia.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Clinical Study ; Hypocalcemia ; Thyroid Surgery.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 12 Oct 2017 00:59
Last Modified: 12 Oct 2017 00:59
URI: http://repository-tnmgrmu.ac.in/id/eprint/3543

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