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Long-term hypocalcemia prediction post thyroidectomy

1 Department of Head and Neck Surgery, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
2 Department of Epidemiology and Biostatistics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India

Correspondence Address:
Nebu Abraham George,
Department of Head and Neck Surgery, Regional Cancer Centre, Thiruvananthapuram - 695 011, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/trp.trp_71_20

Introduction: Hypocalcemia is a common sequela of total thyroidectomy and is usually transient (30%), only a few develop permanent hypoparathyroidism. Till date, no effective risk stratification score to predict hypocalcemia is available that can predict postoperative hypocalcemia. Materials and Methods: This was a prospective observational study including all patients who underwent total or completion thyroidectomy with initial parathormone (PTH) within the normal range in our institution during a 1 year period. Postoperative 6th h PTH fall was noted in all patients and cutoff point for the prediction of long-term hypocalcemia (LTHP) was determined using a paired t-test. Results: Postoperatively, calcium supplementation was initiated in 52% of patients. In 7.6% of patients who had a fall in PTH to more than 80% of preoperative value, calcium supplementation could not be tapered even after 3 months postoperatively. About 66% of patients <20 years of age developed hypocalcemia in the postoperative period. Patients who developed delayed hypocalcemia with initial normal calcium levels had fall in PTH of at least 45%. For individuals below 20 years, a PTH fall of 56% or more required calcium supplementation. The various variables studied failed to attain statistical significance. Conclusions: More than 82% fall in 6th h postoperative PTH predicts long-term hypocalcemia. Post total thyroidectomy, adolescent individuals are at a higher risk of developing hypocalcemia; hence, early calcium supplementation is recommended based on fall in PTH. Weighted score to predict LTHP could not be developed, as none of the risk factors evaluated were statistically significant.

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