Hypocalcemia after Total Thyroidectomy in Graves Disease

Total thyroidectomy has been shown to provide a cost-effective and efficient method of permanently treating Graves disease; however, hypocalcemia can be a common complication.

To evaluate the risk of hypocalcemia after total thyroidectomy in patients with vs without Graves disease.

The 2016 American College of Surgeons National Surgical Quality Improvement Program participant use data files for procedure-targeted thyroidectomy and from 5871 patients were merged. This study included any patient who underwent total thyroidectomy.

Whether symptomatic hypocalcemia developed anytime within 30 days after the thyroidectomy. A clinically severe hypocalcemic event was also evaluated as a secondary outcome measure.

Of the 2143 patients who underwent total thyroidectomy, 222 patients experienced hypocalcemia after surgery, 124 of whom had symptomatic hypocalcemia postoperatively. Among patients with hypocalcemia, 16.3% had Graves disease, whereas only 9.4% of patients without Graves disease experienced significant hypocalcemia. Multivariable logistic regression analysis revealed that women (odds ratio = 1.79; 95% confidence interval = 1.16-2.76; p = 0.009) and patients who underwent parathyroid autotransplantation (odds ratio = 1.91; 95% confidence interval = 1.30-2.81; p = 0.001) were at greater risk of development of hypocalcemia. Older patients were less likely to experience hypocalcemia postoperatively (odds ratio = 0.586; 95% confidence interval = 0.44-0.79; p = 0.0001).

Patients with Graves disease are about twice as likely to experience hypocalcemia or clinically severe hypocalcemia postoperatively than are patients without the disease.