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:
2:
3:
4:
5:

Diagnosis
Surgical techniques
Reoperations
Neck dissection
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.

GENDER DISTRIBUTION

Mean age 40.60 10.82 years

Male to female ratio was 1:7.5

PRESENTING SIGNS AND

SYMPTOMS
Clinical Presentation
Neck mass
Dysphagia
Dyspnea
Weight loss
Cervical lymphadenopathy
Hyperthyroidism

Freque
ncy %
83
4.6
1.5
1.5
1.5
01

PREOPERATIVE DIAGNOSIS
Total Pt(165)
Disease
Simple Multinodular Goiter
MNG (retrosternal
goiter)
Malignancy

113
24
17

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

14
02
01
01
02
05
06

PREOPERATIVE DIAGNOSIS
DIFFUSE GOITER; 4%
HASHIMOTO; 3%

MALIGNANCY; 10%

RETROSTERNAL; 15%

Frequency %
MNG; 68%

MNG

RETROSTERNAL

MALIGNANCY

HASHIMOTO

DIFFUSE GOITER

INCIDENCE OF HYPOCALCEMIA
Incidence of hypocalcemia

Total No of
Patients

Patients with
hypocalcemia
n (%)

165

Pt with hypocalcemis; 17%

33
(20%)
total no of pts

PATIENTS DEVELOPING
HYPOCALCEMIA
Hypocalcemia

Freque
ncy%
20 %

Laboratory
hypocalcemia
Symptomatic
11.5 %
hypocalcemia
Requiring IV Calcium 5.5 %

required Iv Ca; 15%

Hypocalcemia

Lab; 54%
symptomatic; 31%

Lab

symptomatic

required Iv Ca

INCIDENCE OF
HYPOCALCEMIA
ACCORDING TO DISEASE

Disease

Simple MNG
(Euthyroid)
MNG with
Retrosternal Goiter
Malignancy
Hashimoto
thyroiditis
Diffuse Goiter

Total no of
patients
113
24

Incidence of
hypocalcemia
(n ) %
18
(11%)
07

(21%)

17
05

06
01

(25 %)
(20 %)

06

01

(16%)

% HYPOCAlCEMIA

MNG; 11%
DIFFUSE GOITER; 16%

HASHIMOTO; 20%
RETROSTERNAL; 29%

MALIGNANCY; 25%

MNG

RETROSTERNAL

MALIGNANCY

HASHIMOTO

DIFFUSE GOITER

INCIDENCE OF HYPOCALCEMIA
ACCORDING TO SURGERY

Surgery

Patients n

Near total
thyroidectomy
Total thyroidectomy

113

Total thyroidectomy
with neck dissection
Unilateral thyroid
lobectomy &
isthmusectomy

17

35

06

Hypocalcemia
%
20 %
33%
44 %
1%

INCIDENCE OF HYPOCALCEMIA ACCORDING TO

SURGERY
%
NTT; 20%
LOBECTOMY +ISTHNUSECTOMY; 2%

TT WITH NECK DISSECTION; 44%

TT; 33%

NTT

TT

TT WITH NECK DISSECTION

LOBECTOMY +ISTHNUSECTOMY

HYPOCALCEMIA

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).

CONCLUSION
Incidence of transient hypocalcemia found to be
associated with
Thyroid malignancy (25 %)
Total thyroidectomy along with neck
dissection (44 %)
Retrosternal goiter (21 %)

Requiring greater tissue manipulation and danger of

injury to parathyroid glands.

 Permanent hypocalcemia is very rare & observed only in

2 patients requiring long term calcium & Vit D
supplements.