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Incidence of Transient & Permanent Hypocalcaemia After Thyroid
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Incidence of Transient & Permanent Hypocalcaemia After Thyroid Surgery;
A Clinical Audit
Dr Sehrish Siddique (Resident) Surgical Unit 1 BBH, RWP.
INTRODUCTION
Hypocalcaemia after total thyroidectomy is a serious and dangerous complication, requiring prompt diagnosis and proper treatment.
• Transient: 9 to 50 %• Permanent: 0.5 to 13%
The occurrence of such complications has been attribute to
1: Diagnosis 2: Surgical techniques3: Reoperations 4: Neck dissection5: Experience of the surgical team
AIM & OBJECTIVES:
The goal of this study is to evaluate the incidence rate and risk factors of transient and permanent hypocalcaemia in patients, who had undergone thyroidectomies, both with or without radical neck dissections.
MATERIALS & METHODS:• Data of the one sixty five patients was used in the study
from 2013-2015. Work up included:
Serum ionized calcium levels of all patients
• Pre op• Post op
After 24 hours
After 1 week
After 6 weeks
Patients were studied from January 2014 till September 2015.
Symptoms and signs of hypocalcemia registered.
Intraoperative Identification
Sup PT
Inf PT
RLN
RESULTS
• Out of 165 patients forty three (26%) patients belonged from the Rawalpindi district,
• Majority of patients 122 (73%) coming from A.J.K. & Murree.
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
PRESENTING SIGNS AND SYMPTOMS
Clinical Presentation Frequency %
Neck mass 83Dysphagia 4.6Dyspnea 1.5Weight loss 1.5Cervical lymphadenopathy 1.5Hyperthyroidism 01
PREOPERATIVE DIAGNOSIS Disease Total Pt(165)
Simple Multinodular Goiter 113 MNG (retrosternal goiter) 24Malignancy 17 Papillary Follicular Anaplastic
14 02 01
Toxic Goiter 01Hashimoto thyroiditis 02
Diffuse Goiter 05Benign adenomas , follicular Nodules 06
PREOPERATIVE DIAGNOSIS
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 IV 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 (n ) %
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 SURGERY
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 SURGERY
NTT20%
TT33%
TT WITH NECK DISSECTION44%
0.019 % HYPOCALCEMIA
NTT TT TT WITH NECK DISSECTION LOBECTOMY +ISTHNUSECTOMY
Hospital stay was significantly longer in hypocalcemic patients. (4 ± 1 days, range 2-5 days) than others (2 ± 0.5 days, range 1-3 days) (P < 0.001).
In female patients, the ratio of postoperative hypocalcemia was found to be significantly higher when compared to male patients (16% vs 4%, P<0.01).
CONCLUSIONIncidence of transient hypocalcemia found to be associated with
Requiring greater tissue manipulation and danger of injury to parathyroid glands.
• Thyroid malignancy (25 %)• Total thyroidectomy along with neck dissection
(44 %)• Retrosternal goiter (21 %)
• Permanent hypocalcemia is very rare & observed only in 2 patients requiring long term calcium & Vit D supplements.
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