Incidence of Hypocalcemia Post Total Thyroidectomy

In the modern era, total thyroidectomy is being performed as a short-stay procedure. Hypocalcemia is the most common complication post total thyroidectomy. It is a major post-operative complication, causing severe symptoms and increasing hospitalization time. Evaluated the incidence of hypocalcemia in patients after total thyroidectomy. A total of 50 patients presented with thyroid disease in Al-Zahraa University Hospital from January 2022 to December 2022. The overall age range was from 20 to 60 years, and the majority of the patients were females 82%. All selected patients underwent total thyroidectomy for benign and malignant thyroid diseases and followed up by postoperative measurement of serum calcium level and clinical assessment for symptoms and signs of hypocalcemia. In this study post-operative hypocalcemia developed in 12 patients, about 24% of study group (50 patients); 8 patients developed asymptomatic hypocalcemia about 16% of all patients or 66.7% of hypocalcemic patients, while 4 patients developed symptomatic hypocalcemia about 8% of all patients or 33.3% of hypocalcemic patients. The mean of calcium level was pre-operatively 9.38±0.32 and postoperatively 6.76±0.38 and 6.64±0.36 after 24 hours and 48 hours respectively in post-operatively hypocalcemic patients (N=12). In female patients’ postoperative hypocalcemia developed in 26.8% (11/41) of cases, while in male patients it developed in 11.1% (1/9) of cases. incidence of postoperative hypocalcemia 16.6%, 22.2%, 23.5% & 27.8% in 4 age groups; patients aged from 20 to 30, from 30 to 40, from 40 to 50 and from 50 to 60 years respectively. The incidence of postoperative hypocalcemia was 12.9% for benign MNG, 44.4% for malignant thyroid disease, 42.9% for controlled toxic goiter and 33.3% for Hashimoto’s thyroiditis. The incidence of post-operative hypocalcemia was 50%, 45.5%, 16.7% and 15.4% in the groups where the number of parathyroid glands identified in each case was 1 gland, 2 glands, 3 glands and 4 glands respectively. This study demonstrates the incidence of post total thyroidectomy hypocalcemia to be about 24%. The majority of cases developed asymptomatic hypocalcemia and needed no treatment or only oral administration of Ca and vitamin D preparations. There was no permanent hypocalcemia. There is a number of different patients (gender), disease related (etiology of thyroidectomy) and surgical (number of parathyroid glands identified during surgery) risk factors that may be predictive of the development of hypocalcemia following total thyroidectomy that we observed. However, these variables and others should be assessed thoroughly to be taken into account when decisions are being made about how to most effectively prevent or manage hypocalcemia post total thyroidectomy.