Necessity of therapy for post-thyroidectomy hypocalcaemia: a multi-centre experience

Area of Science:

• Endocrinology
• Surgical Complications
• Thyroid Surgery

Background:

• Hypoparathyroidism is a frequent complication of total thyroidectomy (TT).
• Early identification of patients prone to hypocalcemia is crucial for optimizing care and reducing healthcare costs.
• Current methods for predicting post-thyroidectomy hypocalcemia require refinement.

Purpose of the Study:

• To identify predictive markers for hypocalcemia following total thyroidectomy.
• To facilitate early tracing of hypocalcemia-prone patients.
• To optimize patient discharge strategies and avoid unnecessary treatments.

Main Methods:

• Analysis of 995 patients undergoing total thyroidectomy over 18 months.
• Monitoring of serum calcium and parathyroid hormone (PTH) levels at various postoperative time points (12-48 hours).
• Evaluation of pre-operative 25OH vitamin D levels and assessment of PTH decay and calcium decay.

Main Results:

• Significant predictors of hypoparathyroidism included 24-hour calcium decay, PTH drop, presence of symptoms, and parathyroid auto-grafting.
• A combination of these factors demonstrated a 99.2% negative predictive value for developing hypoparathyroidism.
• A 70% PTH drop indicated a 93.75% negative predictive value for transient hypoparathyroidism, and a 12% calcium decay showed a 95.7% negative predictive value.

Conclusions:

• Asymptomatic hypocalcemic patients with less than 70% PTH drop and 12% calcium decay can be safely discharged without immediate treatment.
• Symptomatic patients and those with parathyroid grafting require calcium and vitamin D supplementation.
• These findings enable optimized discharge protocols for post-thyroidectomy patients.