Frequency of Post-Operative Hypocalcemia after Total Thyroidectomy for Graves’ Disease versus Multinodular Goiter
DOI:
https://doi.org/10.51253/pafmj.v75i2.10209Keywords:
Graves’ Disease, Hypocalcemia, Multinodular Goiter, Total Thyroidectomy..Abstract
Objective: To compare the frequency of post-operative hypocalcemia after total thyroidectomy for Graves’ disease compared with multinodular goiter.
Study Design: Quasi experimental study.
Place and Duration of Study: Department of Surgery, Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Mar 2022 to Feb 2023.
Methodology: A total of 161 patients were enrolled and divided into two groups, where Group-A consisted of 110 patients, undergoing total thyroidectomy for multinodular goiter, while Group-B had 51 patients, undergoing total thyroidectomy for Graves’ disease. Participants were enrolled using non-probability sequential sampling. All data was collected on a self-designed data collection tool and manually entered into data analysis software for final analysis.
Results: Our study found hypocalcemia after 24 hours of total thyroidectomy in 11(10.0%) patients of Group-A and 9(17.6%) patients of Group-B, with an additional 21(19.1%) patients from Group-A and 13(25.4%) patients of Group-B when 48 hours had elapsed (p-value=0.06). Serum calcium levels performed two months after surgery detected low levels in 4(3.6%) patients of multinodular goiter and in 7(13.7%) patients with Graves’ disease (p=0.034).
Conclusion: Patients with Graves’ disease have greater likelihood than patients of multinodular goiter, of experiencing transient hypocalcemia and persistent hypocalcemia after total thyroidectomy, warranting more careful monitoring in these patients.
Downloads
References
Azadbakht M, Emadi-Jamali SM, Azadbakht S, et al. Hypocalcemia following total and subtotal thyroidectomy and associated factors. Ann Med Surg 2021; 5(1): 102417.
https://doi.org/10.1016/j.amsu.2021.102417
Khairy GA, Al-Saif A. Incidental parathyroidectomy during thyroid resection: incidence, risk factors, and outcome. Ann Saudi Med 2011; 31(3): 274-278.
Padur AA, Kumar N, Guru A, et al. Safety and effectiveness of total thyroidectomy and its comparison with subtotal thyroidectomy and other thyroid surgeries: a systematic review. J Thyroid Res 2016; 2016: 7594-7615.
https://doi.org/10.1155/2016/7594615
Li Y, Li Y, Zhou X, et al. Total thyroidectomy versus bilateral subtotal thyroidectomy for bilateral multinodular nontoxic goiter: a meta-analysis. ORL 2016; 78(3): 167-175.
https://doi.org/10.1159/000442678
Liu J, Bargren A, Schaefer S, et al. Total thyroidectomy: A safe and effective treatment for Graves’ disease. J Surg Res 2011; 168(1): 1-4.
https://doi.org/10.1016/j.jss.2010.12.038
Tredici P, Grosso E, Gibelli B, et al. Identification of patients at high risk for hypocalcemia after total thyroidectomy. Acta Otorhinolaryngol Ital 2011; 31(3): 144-148.
Viswanathan KV, Jithunath MR, Viswanathan M, et al. Incidence of post-operative hypocalcaemia after thyroidectomy: a case control study. Int J Adv Health Sci 2014; 1(5): 1-9.
Wang YH, Bhandari A, Yang F, et al. Risk factors for hypocalcemia and hypoparathyroidism following thyroidectomy: a retrospective Chinese population study. Cancer Manag Res 2017; 9: 627-630.
https://doi.org/10.2147/CMAR.S130259
Du W, Fang Q, Zhang X, et al. Unintentional parathyroidectomy during total thyroidectomy surgery: A single surgeon's experience. Medicine (Baltimore) 2017; 96(11): e6411.
https://doi.org/10.1097/MD.0000000000006411
Simon G, Jonathan S. Evidence for the role of perioperative PTH measurement after total thyroidectomy as a predictor of hypocalcaemia. World J Surg 2008; 32(7): 1367-1373.
https://doi.org/10.1007/s00268-008-9475-2
Nair GC, Babu MJC, Menon R, et al. Hypocalcemia following total thyroidectomy: an analysis of 806 patients. Indian J Endocrinol Metab 2015; 17(2): 298-303.
https://doi.org/10.4103/2230-8210.149316
Chahardahmasumi E, Salehidoost R, Amini M, et al. Assessment of the early and late complication after thyroidectomy. Adv Biomed Res 2019; 8: 14. https://doi.org/10.4103/abr.abr_42_18
Shomon M. Post-thyroidectomy side effects and recovery. Verywell Health. 2020. Available from:
https://www.verywellhealth.com/recuperating-after-thyroid-surgery-3233273
Sugino K, Nagahama M, Kitagawa W, et al. Change of surgical strategy for Graves’ disease from subtotal thyroidectomy to total thyroidectomy: a single institutional experience. Endocr J 2019; 66(2): 181-186. https://doi.org/10.1507/endocrj.EJ18-0312
Cipolla C, Graceffa G, Calamia S, et al. The value of total thyroidectomy as the definitive treatment for Graves’ disease: A single centre experience of 594 cases. J Clin Transl Endocrinol 2019; 16: 100183. https://doi.org/10.1016/j.jcte.2019.100183
Al Qubaisi M, Haigh PI. Hypocalcemia after total thyroidectomy in Graves’ disease. Perm J 2019; 23: 18-188.
https://doi.org/10.7812/TPP/18-188
Dogar MA, Riaz A, Umar M, et al. Incidence of Hypocalcaemia in Patients Undergoing Total Thyroidectomy. Pak Armed Forces Med J 2019; 30(11): 49-52.
Azadbakht M, Emadi-Jamali SM, Azadbakht S. Hypocalcemia following total and subtotal thyroidectomy and associated factors. Ann Med Surg 2021; 66: 102417.
https://doi.org/10.1016/j.amsu.2021.102417
Athisayaraj T, Sebastian B, Kumar B, et al. Is Development Of Hypocalcaemia A Surrogate Marker For Experience Of Operating Surgeon In Thyroidectomies? Int J Med Biomed Stud 2020; 4(5): 36-41.
https://doi.org/10.32553/ijmbs.v4i5.1164
Qin Y, Sun W, Wang Z, et al. A meta-analysis of risk factors for transient and permanent hypocalcemia after total thyroidectomy. Front Oncol 2021; 10: 614089.
https://doi.org/10.3389/fonc.2020.614089
Sajid T, Naqvi SR, Sajid Z, et al. Hypocalcemia in total versus subtotal thyroidectomy. Pak Armed Forces Med J 2021; 71(Suppl-3): S630-S633.
Edafe O, Antakia R, Laskar N, et al. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg 2014; 101(4): 307-320.
https://doi.org/10.1002/bjs.9384
Villarroya-Marquina I, Lorente-Poch L, Sancho J, et al. Influence of gender and women's age on the prevalence of parathyroid failure after total thyroidectomy for multinodular goiter. Gland Surg 2020; 9(2): 245-251.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Muhammad Ibtisam Raza, Syeda Rifaat Qamar Naqvi, Saima Qamar Naqvi, Hamza Ali Malik, Shahid Mehmood Khan, Umer Mushtaq Rizvi

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.