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KMID : 0371320010610060572
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Journal of the Korean Surgical Society
2001 Volume.61 No. 6 p.572 ~ p.577
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Post-thyroidectomy Hypocalcemia in HighRisk Patients Following Total Thyroidectomy
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Hong Seong-Hee
Xu Xue-Jun
Hong Suck-Joon
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Abstract
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Purpose : Parathyroid injury is the major cause of post-thyroidectomy hypocalcemia. This prospective study aimed to define the relation between the preservation status of the parathyroid glands and post-thyroidectomy hypocalcemia as well
as
to
determine whether the number of preserved parathyroid glands could be a guideline for the management of post-thyroidectomy hypocalcemia.
Methods : We analyzed a total of 76 cases of total thyroidectomy due to malignancy were analysed. Parathyroid gland status at the end of thyroidectomy was classified as preserved intact, discolored (color change or equivocal viability), or
autotransplanted. Patients were grouped according to the number of intact preserved parathyroid glands into group 1 (more than two), group 2 (one), or group 3 (zero). The total and ionized serum calcium levels of each group were monitored for
three
days
after surgery.
Results : The number of intact preserved parathyroid glands was not found to be closely related to serum calcium level, although ionized serum calcium level was significantly lower in group 1 than group 2 (P<0.001). Hypocalcemia was not
found in
group 1. Hypocalcemia was found in 31% (10/32) of group 2. Among the 32 patients of group 2, all 4 parathyroid gland were identified in 9 patients and 4 patients were shown to be hypocalcemic. Therefore, the incidence of hypocalcemia for patients
in
whom only one intact parathyroid was preserved and all 4 parathyroid were indentified was 44% (4/9). Hypocalcemia was transient in all patients.
Conclusion : The parathyroid glands should be preserved as much as possible to minimize post-thyroidectomy hypocalcemia. The number of intact preserved parathyroid glands can be a good guideline for predicting post-thyroidectomy
hypocalcemia
and
proper care management.
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KEYWORD
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