Outcome of hypocalcaemia after thyroidectomy treated only in symptomatic patients
| Autor: | J Järhult, K Landerholm |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Parathyroidectomy medicine.medical_specialty medicine.medical_treatment chemistry.chemical_element 030230 surgery Calcium Asymptomatic Parathyroid Glands 03 medical and health sciences Postoperative Complications 0302 clinical medicine medicine Vitamin D and neurology Humans Hypocalcaemia Vitamin D Hypocalcemia business.industry Thyroid Thyroidectomy Middle Aged medicine.disease Surgery medicine.anatomical_structure ROC Curve Hypoparathyroidism chemistry 030220 oncology & carcinogenesis Dietary Supplements Female medicine.symptom business |
| Zdroj: | British Journal of Surgery. 103:676-683 |
| ISSN: | 1365-2168 0007-1323 |
| DOI: | 10.1002/bjs.10086 |
| Popis: | Background Calcium supplementation has been proposed after bilateral thyroid surgery, either to all patients or to those with biochemical hypocalcaemia. It has also been suggested that supplementation aids parathyroid recovery and prevents permanent hypoparathyroidism. This single-centre study investigated the feasibility of a restrictive management of post-thyroidectomy hypocalcaemia. Methods Serum calcium was checked before surgery, on postoperative day 1 (POD) 1, at a follow-up visit 6–8 weeks after surgery and after a minimum of 12 months in all patients. Regardless of serum calcium levels, patients with symptoms of hypocalcaemia were prescribed oral calcium supplementation (0·5–1·0 g twice daily) and asymptomatic patients were not. Asymptomatic patients were informed about hypocalcaemic symptoms and instructed to contact the surgical ward should symptoms appear. Results Some 640 patients underwent bilateral thyroid surgery without previous or intentional simultaneous parathyroidectomy. A subnormal serum calcium level (below 2·15 mmol/l) was observed in 412 patients (64·4 per cent) on POD 1. By comparison, only 63 patients (9·8 per cent) experienced symptoms of hypocalcaemia in the postoperative period, all but one with a corresponding biochemical hypocalcaemia on POD 1. Calcium levels in all patients with asymptomatic postoperative hypocalcaemia recovered to normal without supplementation. Serum calcium was also normalized during follow-up in all symptomatic patients, except 22 (3·4 per cent) who became permanently hypoparathyroid. No patient without early hypocalcaemic symptoms developed permanent hypoparathyroidism. Conclusion The proposed restrictive management of postoperative hypocalcaemia after bilateral thyroid surgery avoids unnecessary supplementation for most patients. |
| Databáze: | OpenAIRE |
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