2. Hypocalcemia Following Thyroid
Surgery in Tobruk Medical Center ,
Libya
M.B; B.Ch.; Faculty of Medicine
Omar El-mukhtar University- Libya
Master degree ; Faculty of Medicine
Benghazi University- Libya
Thesis by
3. Prof. Dr.
Salah El Taktuk
Professor of General surgery
Faculty of Medicine – Benghazi University
Dr.
Fathi Ahmed Abdalla
Assistant Professor of General surgery
Faculty of Medicine, Tobruk University
Dr.
Farag Abdalla Eljali
Assistant Professor of General surgery
Faculty of Medicine, Tobruk University
4.
5. • THYROID DISORDERS ARE AMONG THE MOST
COMMONLY OCCURRING ENDOCRINE GLAND DISEASES
WORLDWIDE. THEY CAN BE TREATED EITHER MEDICALLY
OR SURGICALLY. THYROIDECTOMY (PARTIAL OR TOTAL)
IS ONE OF THE MOST FREQUENT OPERATIONS
PERFORMED GLOBALLY .
• COMPRESSION SYMPTOMS, SUSPECTED OR KNOWN
MALIGNANCY, PRESENCE OF A SOLITARY COLD NODULE
IN PATIENTS AGED <20 YEARS, COSMETIC REASONS, AND
THE PRESENCE OF A COMPLEX CYST OR A CYST >4 CM IN
DIAMETER ARE ALL INDICATIONS FOR THYROIDECTOMY.
6. • THYROID SURGERY IS NOW CONSIDERED A SAFE
PROCEDURE. HOWEVER, COMPLICATIONS FOLLOWING
THYROID SURGERY MAY OCCUR. THESE COMPLICATIONS
INCLUDE HYPOCALCEMIA, RECURRENT LARYNGEAL
NERVE INJURY, HEMATOMA, SEROMA, STRIDOR, LOSS OF
HIGH-PITCHED VOICE, THORACIC DUCT INJURY, WOUND
INFECTION, AND TRACHEAL INJURY.
• SUCH COMPLICATIONS OCCUR LESS FREQUENTLY WHEN
THE SURGERY IS PERFORMED BY EXPERIENCED
SURGEONS).
• HYPOCALCEMIA AND RECURRENT LARYNGEAL NERVE
7. • POST-THYROIDECTOMY COMPLICATIONS
MAY BE ASSOCIATED WITH SOME RISK
FACTORS SUCH AS AGE, SEX, INCREASED
GLAND SIZE, TYPE OF THYROID DISEASE,
PRESENCE OF FIBROSIS AND INFLAMMATION,
EXTENT OF THYROIDECTOMY, AND LYMPH
NODE DISSECTION
11. Patients Selection
This Prospective study was conducted on
52 patients in general surgery Department
of Tobruk medical center (Tobruk, Libya)
during the period from (October 2019 to
October 2020).
12. Inclusion Criteria:
•
Patient aged more than 12 Years including
both gender with clinically and
pathologically diagnosed thyroid swellings
undergoing thyroid surgery, regular
attended to outpatient clinics are included.
13. Exclusion Criteria:
•
* Patients undergoing
hemithyroidectomy/lobectomy .
Primary parathyroid pathologies.
*
* Aged < 12 years .
* Previous irradiation to neck and patient
already on calcium supplementation.
14. Methods:
All included patients are:
collected from the patients undergoing total
thyroidectomy were subjected to Full history taking ,
proper clinical examination and appropriate
radiological, hematological investigations including
serum calcium and PTH , operative findings and follow-
up of the cases. Patients with pre-operative
hypocalcemia were excluded.
15.
16. Table (1): AGE WISE DISTRIBUTION OF TOTAL
THYROIDECTOMY :
AGE IN YEARS NO.
OF PATIENTS
PERCENTAGE
< 30 5 10%
31-40 18 34%
41-50 17 33%
> 50 12 23%
17. Table (2): INCIDENCE OF POST OPERATIVE HYPOCALCEMIA
IN RELATION TO AGE GROUP:
AGE IN YEARS
HYPOCALCEMIA
PRESENT ABSENT
< 30 2 3
31-40 7 11
41-50 4 13
> 50 6 6
18. Table (3): INCIDENCE OF POST OP HYPOCALCEMIA IN
RELATION TO TYPE OF SURGERY:
TYPE OF SURGERY
NO. OF
PATIENTS
HYPOCALCEMIA
PRESENT
TOTAL
THYROIDECTOMY
50 18
COMPLETION
THYROIDECTOMY
2 1
19. Table (4): INCIDENCE OF POST OP HYPOCALCEMIA IN
RELATION TO RISK FACTORS:
RISK FACTORS
TOTAL
CASES
HYPOCALCEMIA
PRESENT
HUGE GOITRE 9 7
NECK NODE DISSECTION 1 1
SHORT NECK/OBESITY 6 3
PREVIOUS THYROID
SURGERY
2 2
20. Table (5 ) CORRELATION BETWEEN IONISED CALCIUM AND
POST OPERATIVE THYROID SURGERY:
HPE DIAGNOSIS
IONISED CALCIUM LEVELS
MEAN SD
NODULAR/COLLOID GOITRE 5.04 0.53
CARCINOMA 4.12 0.35
GRAVES DISEASE 4.33 0.28
TOXIC MNG 4.35 0.35
ADENOMA 4.94 0.48
HASHIMOTO THYROIDITIS 4.62 0.6
P VALUE - 0.001 SIGNIFICANT
22. In this study of 52 patients who with various thyroid
pathology underwent total thyroidectomy or
completion thyroidectomy consecutively during the
period from October 2019 – October 2020.
Most of our cases who underwent total thyroidectomy
were female[female-48,male-4] most of them in the
age group of 30-50 years.
Colloid goitre or multi nodular goitre is the most
common indication for surgery in this study.
23. Risk factors like huge goitre, short neck, obesity, previous
thyroid surgery, associated neck node dissection which
increases the incidence of post operative hypocalcemia
observed in this study. Sakouti et al,2010 was noted
thyroid malignancy combined with neck node dissection
increases the incidence of post operative hypocalcemia
where as in Noureldine et al.,2014
there is no association between neck node dissection and
hypocalcemia but randomised controlled trial showed that
patients who undergone neck node dissection along with
thyroidectomy were at high risk of developing post operative
hypocalcemia.
24. Incidence of post operative hypocalcemia [serum ca <8.5mg/dl].
According to various study :
Table(6): Incidence of post operative hypocalcemia
Thomson et al (2005) 4.1%
Sesson et al, (2007) 6.6%
American college of
surgeons,(2013)
8%
McKenzie et al, (2013) 27%
Present study 35.4%
25. TABLE(7) INCIDENCE OF TRANSIENT AND PERMANENT
HYPOCALCEMIA
Study Transient Permanent
Thomusch et al,(2003) 7.3% 1.5%
Ganecalvesseries,(2010) 25.5% 5.1%
Fahmy et al,(2004) 5.4-26% 0.5-24%
Karamanakos et al,(2010) 6.9-46% 0.4- 33%
present study 33.5% 1.9%
27. It can be concluded that transient hypocalcemia is
the most common complication following total
thyroidectomy.
The incidence of post operative hypocalcemia is
35.4% [transient hypocalcemia 33.5% and permanent
hypocalcemia 1.9%].
28. INCIDENCE OF POST OPERATIVE HYPOCALCEMIA MORE IN
NODULAR/COLLOID GOITRE AND THYROID MALIGNANCY.
THE RISK FACTORS LIKE HUGE GOITRE , SHORT NECK, OBESITY,
PREVIOUS THYROID SURGERY AND ASSOCIATED NECK NODE
DISSECTION INCREASES THE INCIDENCE OF POSTOP
HYPOCALCEMIA.
FINALLY A PROPER FOLLOW UP SCHEDULE IS MANDATORY IN ALL
PATIENTS UNDERGOING TOTAL THYROIDECTOMY WHO DEVELOPED
HYPOCALCEMIA IN THEIR POST OPERATIVE PERIOD
