Incidence Of Post Thyroidectomy Hypocalcemia 5y384g

SIDDIQUE

DR SEHRISH

PGT SURGICAL UNIT 1 BBH,RWP

Incidence of Hypocalcemia after Thyroid Surgery: A retrospective study

Dr Sehrish Siddique Resident Surgical Unit 1 BBH, RWP.

INTRODUCTION Hypocalcemia is a most common known complication after thyroidectomy, requiring prompt diagnosis and proper treatment. Incidence being: • Transient: • Permanent:

04 to 42 % 0 to 08%

Int J Endocrinol Metab 2010; 1: 7-12

The occurrence of such complications has been attributed to 1: 2: 3: 4: 5:

Pathology requiring thyroidectomy Surgical techniques Reoperations Neck dissection Experience of the surgical team

AIM & OBJECTIVES: The goal of this study is to evaluate the incidence and risk factors contributing to hypocalcemia, in patients who have undergone thyroidectomy.

MATERIALS & METHODS: Retrospective study of the 165 consecutive thyroidectomies from Jan 2013- May 2015. Work up included: Serum calcium levels of all patients • Pre op • Post op After 24 hours After 1 week After 6 weeks

IDENTIFICATION OF PARATHYROIDS DURING THYROIDECTOMY Routinely

• Recurrent laryngeal nerve and parathyroid are identified and preserved as standard procedure. • Branches and not the main trunk of inferior thyroid artery are ligated individually.

Routinally all the patients undergoing thyroidectomies are observed post operatively for Symptoms and signs of hypocalcemia. Documented and managed.

Demography Mean age 40.60± 10.82 years Male to female ratio was 1:7.5

GENDER DISTRIBUTION

Clinical Presentation

Neck mass Dysphagia Dyspnea Cervical lymphadenopathy Hyperthyroidism (controlled pre op)

Frequen cy % 83 4.6 1.5 1.5 05

PATHOLOGY Disease Simple Multinodular Goiter with retrosternal extension Malignancy

Total Pt(165) 113 21 17

Papillary Follicular Anaplastic Toxic Goiter Hashimoto thyroiditis Benign adenomas , follicular Nodules

14 02 01 06 04 04

PATHOLOGY

DIFFUSE GOITER; 4% HASHIMOTO; 3%

MALIGNANCY; 10%

RETROSTERNAL; 15%

Frequency %

MNG; 68%

MNG

RETROSTERNAL

MALIGNANCY

HASHIMOTO

DIFFUSE GOITER

INCIDENCE OF HYPOCALCEMIA

INCIDENCE OF HYPOCALCEMIA Incidence of hypocalcemia

Total No of Patients

165

Patients with hypocalcemia n (%) 33 (20%)

Pt with hypocalcemis; 17%

total no of pts

PATIENTS DEVELOPING HYPOCALCEMIA Hypocalcemia

Frequency %

Laboratory hypocalcemia 20 % Symptomatic hypocalcemia

11.5 %

Requiring I.V. Calcium

5.5 %

INCIDENCE OF HYPOCALCEMIA ACCORDING TO DISEASE

INCIDENCE OF HYPOCALCEMIA ACCORDING TO DISEASE Disease

Total no of patients n=165 113

Incidence of hypocalcemi a n= 33 18

Frequenc y %

Simple MNG (Euthyroid) Retrosternal Goiter Malignancy

21 17

06

35%

Thyrotoxicosis

06

01

16%

Hashimoto’s

04

01

25%

07

15% 33%

% HYPOCAlCEMIA MNG; 12% Thyrotoxicosis; 20%

HASHIMOTO; 13%

RETROSTERNAL; 27%

MALIGNANCY; 28%

MNG

RETROSTERNAL

MALIGNANCY

HASHIMOTO

Thyrotoxicosis

INCIDENCE OF HYPOCALCEMIA ACCORDING TO TYPE OF THYROIDECTOMY

INCIDENCE OF HYPOCALCEMIA ACCORDING TO TYPE OF THYROIDECTOMY Surgery Patients Hypocalce Hypocalce n=165 Near total thyroidectomy Total thyroidectomy Total thyroidectomy with neck dissection

mia

mia % 16 %

134

n=33 24

10

03

30%

17

06

35 %

INCIDENCE OF HYPOCALCEMIA ACCORDING TO TYPE OF THYROIDECTOMY % HYPOCALCEMIA NTT; 25%

TT WITH NECK DISSECTION; 48%

TT; 27%

NTT

TT

TT WITH NECK DISSECTION

PERMANENT HYPOCALCEMIA Hypocalcemia persistent after 6 months can be labelled as permanent. Hypocalcemia

Total Patients with hypocalcemia Patients with transient Patients with permanent

33/165

31/33 2/33 Acta Otorhinolaryngol Ital. 2011 Jun; 31(3): 144–148

CONCLUSION In this study Incidence of hypocalcemia is 20 %. Higher in patients with • Thyroid malignancy

35 %

• Total thyroidectomy 35% along with neck dissection • Retrosternal goiter

33 %

CONCLUSION Operation requiring greater tissue manipulation cause greater damage to parathyroid glands resulting into hypocalcemia.

Surgeons BE AWARE of it

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