Post Total Thyroidectomy Hypocalcemia in Toxic MNG and Effect of Post-operative Intravenous Calcium Gluconate in its Incidence

Muhammad Ahsan Mustafa; Muhammad Saeed Akhtar; Muhammad Hassan Abbas; Sajjad Ahmad Ansari; Kaleem Akhtar; Fatima Akram

doi:10.51253/pafmj.v76iSUPPL-1.12586

Authors

Muhammad Ahsan Mustafa Department of Surgery, Combined Military Hospital Bahawalpur/National University of Medical Sciences (NUMS) Pakistan
Muhammad Saeed Akhtar Department of Surgery, Combined Military Hospital Bahawalpur/National University of Medical Sciences (NUMS) Pakistan
Muhammad Hassan Abbas Department of Surgery, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan Pakistan
Sajjad Ahmad Ansari Department of Surgery, Combined Military Hospital Bahawalpur/National University of Medical Sciences (NUMS) Pakistan
Kaleem Akhtar Department of Surgery, SKBZ/Azad Jammu and Kashmir Medical College, Muzaffarabad/ Combined Military Hospital, Muzaffarabad /National University of Medical Sciences (NUMS) Pakistan
Fatima Akram Shahida Islam Medical College, Lodhran Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-1.12586

Keywords:

Calcium level, Calcium Gluconate, Hypocalcemia, Incidence, Multinodular goiter, Total thyroidectomy, Toxic

Abstract

Objective: To see the effects of post-operative intravenous calcium gluconate infusion on post-total thyroidectomy calcium levels in toxic multinodular thyroid patients.

Study Design: Randomized control trial (IRCT20240503061640N1).

Place and Duration of Study: Combined Military Hospital Bahawalpur, Pakistan from Nov 2023 to Jul 2024.

Methodology: Patients with toxic multinodular goiter and having normal calcium levels were included. Baseline parameters, history, and pre-operative calcium levels were measured. Patients were divided into two groups: one interventional group which was given intravenous calcium gluconate infusion, and the other control group was given intravenous normal saline infusion as a placebo. Post-operative measures like calcium level, hospital stay, severe hypocalcemia symptoms, Chvostek sign, Trousseau sign and need for calcium supplements were noted.

Results: Out of seventy-two patients 36 were assigned to each group. Both group shows no significant difference between baseline parameters. The mean value of the post-operative calcium level of the interventional group was 9.472±0.582 mg/dl and the control group was 8.863±0.555 mg/dl with a statistically significant difference (p-value <0.001). The control group shows a significant number of hypocalcemia patients as compared to the interventional group with a p-value of 0.017.

Conclusion: This study concluded that the post-operative use of calcium gluconate reduces the incidence of hypocalcemia in post-thyroidectomy patients with toxic multinodular goiter. Not only does it reduce severe symptoms of hypocalcemia but also reduces the post-operative need for calcium supplements and hospital stay thus ensuring better recovery.

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References

1. Alqahtani SM, Alatawi AS, Alalawi YS. Post-thyroidectomy hypocalcemia: a single-center experience.Cureus 2021; 13(11) e20006. http://doi.org/10.7759/cureus.20006

2. Layegh P, Sajjadi ZS, Mostaan LV, Mohebbi M, Kabiri M, Yaghoubi MA et al. Preoperative Vitamin. D Status and Post-Total Thyroidectomy Hypocalcemia. Iranian J Otorhinolaryngol 2024; 36(1): 343.

3. Alqahtani SM, Almussallam B, Alatawi AS, Alsuhaimi NA, Albalawi A, Albalawi NS, et al. Post-thyroidectomy complications and risk factors in Tabuk, Saudi Arabia: a retrospective cohort study. Cureus. 2020; 12(10). e10852. https://doi.org/10.7759%2Fcureus.10852

4. Sharifi A, Rousta F. Hypocalcemia: Why does this happen after thyroidectomy?. Eurasian J Chem Med Petroleum Res 2023; 2(4): 329-339. https://doi.org/EJCMPR/20231215

5. Sittitrai P, Ruenmarkkaew D, Klibngern H, Ariyanon T, Hanprasertpong N, Boonyaprapa S, et al. Perioperative versus postoperative calcium and vitamin D supplementation to prevent symptomatic hypocalcemia after total thyroidectomy: a randomized placebo controlled trial. Int J Surgery 2023; 109(1): 13-20. https://doi.org/DOI:10.1097/JS9.0000000000000192

6. Soares CS, Oliveira CC, Koga KH, Moriguchi SM, Terra SA, Tagliarini JV, et al. Postoperative serum magnesium levels as a predictor for the need for calcium replacement after total thyroidectomy: a prospective study. Arch Endocrinol Metabol 2023; 67(3): 355-360.

https://doi.org/10.20945/2359-3997000000581

7. Pepe J, Colangelo L, Biamonte F, Sonato C, Danese VC, Cecchetti V, et al. Diagnosis and management of hypocalcemia. Endocrine 2020; 69: 485-495.

https://doi.org/10.1007/s12020-020-02324-2

8. Stack Jr BC, Bimston DN, Bodenner DL, Brett EM, Dralle H, Orloff LA, et al. American association of clinical endocrinologists and American college of endocrinology disease state clinical review: postoperative hypoparathyroidism-definitions and management. Endocrine Pract 2015; 21(6): 674-685. https://doi.org/10.4158/ep14462.dsc

9. Uruno T, Miyauchi A, Shimizu K, Tomoda C, Takamura Y, Ito Y, et al. A prophylactic infusion of calcium solution reduces the risk of symptomatic hypocalcemia in patients after total thyroidectomy. World J Surg 2006; 30(3): 304-308.

https://doi.org/10.1007/s00268-005-0374-5

10. Khaghan BS, Junaid F, Hussain SA, Noor AI, Iqbal T, Maham M et al. Role of Prophylactic Administration of Calcium Gluconate in the Early Post Operative Period after Total Thyroidectomy at Surgical department Ayub Teaching Hospital Abbottabad. Med Forum Month 2023; 34(9). 169-172.

11. Miki H, Inoue H, Kitaichi M, Masuda E, Komaki K, Monden Y et al. Estimation of free calcium levels after thyroidectomy. Journal of Med Invest 1997; 44 (1-2): 83-88.

12. Arer IM, Kus M, Akkapulu N, Aytac HO, Yabanoglu H, Caliskan K, et al. Prophylactic oral calcium supplementation therapy to prevent early post thyroidectomy hypocalcemia and evaluation of postoperative parathyroid hormone levels to detect hypocalcemia: a prospective randomized study. Int J Surg 2017; 38(1): 9-14.

https://doi.org/10.1016/j.ijsu.2016.12.041

13. Pãduraru DN, Ion D, Carsote M, Andronic O, Bolocan A. Post-thyroidectomy hypocalcemia-risk factors and management. Chirurgia 2019; 114(5): 564-570.

http://doi.org/10.21614/chirurgia.114.5.564

14. Hoffman E. The Chvostek sign: a clinical study. Am J Surg 1958; 96(1): 33-37.

https://doi.org/10.1016/0002-9610(58)90868-7

15. Fonseca OA, Calverley JR. Neurological manifestations of hypoparathyroidism. Arch Int Med 1967; 120(2): 202-206.

https://doi.org/10.1001/archinte.1967.00300020074009

16. Nicholson KJ, Smith KJ, McCoy KL, Carty SE, Yip L. A comparative cost-utility analysis of postoperative calcium supplementation strategies used in the current management of hypocalcemia. Surgery 2020; 167(1): 137-143.

https://doi.org/doi:10.1016/j.surg.2019.05.077

17. Ghafouri A, Shirangi S, Mohseni S, Shojaiefard A, Khorgami Z, Hedayat A et al. Prophylactic oral calcium reduces symptomatic hypocalcemia in patients undergoing total or subtotal thyroidectomy: a randomized controlled trial. Acad J Surg 2014; 1(3-4): 40-44.

18. McHenry CR. Same-day thyroid surgery: An analysis of safety, cost savings, and outcome. Am Surg 1997; 63(7): 586.