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[Total thyroidectomy with identification of parathyroid glands. Functional implications]
C Giovannini1, M Cristaldi, R Pirozzi
1Clinica Chirurgica VI, Università degli Studi di Roma La Sapienza.
Annali Italiani Di Chirurgia
|August 31, 1999
Summary
Transient hypocalcemia after total thyroidectomy (TT) occurred in 13.6% of patients. Surgical manipulation of parathyroid glands likely causes temporary PTH reduction and subsequent hypocalcemia.
Area of Science:
- Endocrinology
- Surgical Oncology
Background:
- Postoperative hypocalcemia is a known complication after total thyroidectomy (TT).
- The exact cause of hypocalcemia following TT remains unclear, though hypoparathyroidism is considered a primary factor.
Purpose of the Study:
- To investigate the incidence and potential causes of hypocalcemia after TT.
- To evaluate the role of parathyroid gland manipulation in postoperative calcium levels.
Main Methods:
- 337 patients underwent TT with meticulous identification and preservation of parathyroid glands.
- Serum calcium levels were monitored preoperatively and on days 1, 2, 4, 15, and 30 postoperatively.
- In a subset of 90 patients, phosphorus, magnesium, alkaline phosphatase, total proteins, parathyroid hormone (PTH), calcitonin, and urinary calcium/phosphorus were also assessed.
Main Results:
- No permanent hypocalcemia was recorded; transient hypocalcemia occurred in 13.6% of patients.
- In 6 patients with early postoperative hypocalcemia, PTH levels decreased, and phosphorus levels increased, with normalization within 30 days.
- The remaining 84 patients in the detailed subgroup maintained normal serum calcium and PTH levels.
Conclusions:
- Surgical manipulation of parathyroid glands appears to be the cause of transient decreases in PTH concentration.
- This transient PTH reduction is likely responsible for the observed cases of temporary hypocalcemia after TT.