Fluctuation of Corrected Serum Calcium Levels Following Partial and Total Thyroidectomy
Vikas Malik, Glen J. Watson, Chu Q. Phua, Prad Murthy
DOI: 10.4236/ijcm.2011.24069   PDF    HTML     6,134 Downloads   9,822 Views   Citations


Objectives: To identify any fluctuation of corrected serum calcium levels and to determine the presence of sub-clinical hypocalcaemia following partial and total thyroidectomy with preservation of at least two parathyroid glands. Design: A prospective study. Setting: Tertiary Head & Neck referral unit. Patients: Eighty five patients undergoing partial or total thyroidectomy with or without laryngectomy from April 2003 to April 2009 were included in the study. Corrected serum calcium levels (CCSL) were noted preoperatively and postoperatively on day 1, day 7 and 6 months. Results: Forty six patients underwent hemi-thyroidectomy (HT), 29 underwent total thyroidectomy (TT) and 10 underwent total thyroidectomy with laryngectomy (TTL). Nine (19.56%) patients in the HT group, 6 (24.14%) in the TT group and 3 (30.0%) in the TTL group developed hypocalcaemia postoperatively which was most significant on 1st postoperative day. This improved by 7th postoperative day in each group when the change in calcium levels became statistically insignificant. Six patients (3 patients had HT, 2 had TT and 1 had TTL) developed sub-clinical mild hypocalcaemia which was persistent at 6 months follow-up. Conclusion: The most significant changes in corrected serum calcium levels occur within first 24 hours after thyroid surgery. Thereafter most patients return to normocalcaemia within a seven-day period. Despite preservation of parathyroid glands there is a subgroup of patients who develop sub-clinical hypocalcaemia which persists even at six months but does not require treatment.

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V. Malik, G. Watson, C. Phua and P. Murthy, "Fluctuation of Corrected Serum Calcium Levels Following Partial and Total Thyroidectomy," International Journal of Clinical Medicine, Vol. 2 No. 4, 2011, pp. 411-417. doi: 10.4236/ijcm.2011.24069.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] N. Mehta, N. B. Watts, J. A. Welge and D. Steward, “Comparison of Serum Calcium Change Following Thyroid and Non-Thyroid Neck Surgery,” Otolaryngology— Head and Neck Surgery, Vol. 134, No. 6, 2006, pp. 901-906.
[2] C. Bourell, B. Uzzan, G. Y. Perret, et al., “Transient Hypocalcaemia after Thyroidectomy,” Annals of Otology, Rhinology and Laryngology, Vol. 102, No. 7, 1993, pp. 496-501.
[3] P. Lindblom, J. Westerdahl and A. Bergenfelz, “Hemi- thyroidectomy: Long Term Effects on Parathyroid Function a Preliminary Report,” World Journal of Surgery, Vol. 25, No. 9, 2001, pp. 1155-1159. doi:10.1007/BF03215864
[4] A. Bergenfelz and B. Ahren, “Calcium Metabolism after Hemithyroidectomy,” Hormone Research, Vol. 39, No. 1-2, 1993, pp. 56-60. doi:10.1159/000182696
[5] E. Eforakopoulou-Gialakidou, D. A. Koutras, S. D. Moulopoulos, et al., “Thyroid and Parathyroid Response to Subtotal Thyroidectomy,” Endocrinologia Experimentalis, Vol. 22, No. 3, 1988, pp. 165-169.
[6] T. Meyer, S. Merkel, W. Hohenberger, et al., “Dysfunction of Calcium Metabolism Following Resection of the Thyroid Gland. An Analysis of important Risk Factors,” Zentralblatt fur Chirurgie, Vol. 127, No. 5, 2002, pp. 429-434. doi:10.1055/s-2002-31972
[7] P. Del Rio, M. F. Arcuri, M. Sianesi, et al., “The Utility of Serum PTH Assessment 24 Hours after Total Thyroidectomy,” Otolaryngology—Head & Neck Surgery, Vol. 132, No. 4, 2005, pp. 584-586.
[8] R. M. Quiros, C. E. Pesce, R. A. Prinz, et al. “Intraoperative Parathyroid Hormone Levels in Thyroid Surgery Are Predictive of Postoperative Hypoparathyroidism and Need for Vitamin D Supplementation,” American Journal of Surgery, Vol. 189, No. 3, 2005, pp. 306-309. doi:10.1016/j.amjsurg.2005.01.006
[9] A. Lam and P. D. Kerr, “Parathyroid Hormone: An Early Predictor of Post Thyroidectomy Hypocalcaemia,” Laryngoscope, Vol. 113, 2003, pp. 2196-2200.
[10] C. P. Lombardi, M. Raffaelli, R. Bellantone, et al., “Early Prediction of Post Thyroidectomy Hypocalcaemia by One Single iPTH Measurement.” Surgery, Vol. 136, 2004, pp. 1236-1241.
[11] A. Vescan, I. Witterick and J. Freeman, “Parathyroid Hormone as a Predictor of Hypocalcaemia after Thyroidectomy,” Laryngoscope, Vol. 115, No. 12, 2005, pp. 2105-2108.
[12] R. Bellantone, C. P. Lombaedi, P. Princi, et al., “Is Routine Supplementation Therapy (Calcium and Vitamin D) Useful after total Thyroidectomy?” Surgery, Vol. 132, No. 6, 2002, pp. 1109-1112.
[13] C. R. McHenry, T. Speroff, R. A. Prinz, et al., “Risk Factors for Post-Thyroidectomy Hypocalcaemia,” Surgery, Vol. 116, No. 10, 1994, pp. 641-648.
[14] N. Bhattacharyya and M. P. Fried, “Assessment of the Morbidity and Complications of Total Thyroidectomy,” Archives of Otolaryngology and Head & Neck Surgery, Vol. 128, No. 4, 2002, pp. 389-392.
[15] C. Nies, H. Sitter, M. Rothmund, et al. “Parathyroid Function Following Ligation of the Inferior Thyroid Arteries during Bilateral Subtotal Thyroidectomy,” British Journal of Surgery, 1994, Vol. 81, No. 12, pp. 1757-1759. doi:10.1002/bjs.1800811215
[16] V. J. Araujo-Filho, G. B. Silva-Filho, A. R. Ferraz, et al., “The Importance of the Ligation of the Inferior Thyroid Artery in Parathyroid Function after Subtotal Thyroidectomy,” Rev Hosp Clin Fac Med Sao Paulo, Vol. 55, No. 4, 2000, pp. 113-120. doi:10.1590/S0041-87812000000400002
[17] M. Dolapci, M. Doganay, N. A. Kama, et al., “Truncalligation of the Inferior Thyroid Arteries Does not Affect the Incidence of Hypocalcaemia after Thyroidectomy,” European Journal of Surgery, Vol. 166, No. 4, 2000, pp. 286-288. doi:10.1080/110241500750009096
[18] G. Maralcan, Z. Sayin, N. Aybasti, et al., “Does Truncal Ligation of the Inferior Thyroid Arteries during Bilateral Subtotal Thyroidectomy Affect Serum Calcium Levels?” International surgery, Vol. 91, No. 4, 2006, pp. 211-216.
[19] C.-Y. Lo and K.-Y. Lain, “Parathyroid Auto-Transplantation during Thyroidectomy: Is Frozen Section Necessary?” Archives of Surgery, Vol. 134, No. 3, 1999, pp. 258-260. doi:10.1001/archsurg.134.3.258
[20] E. M. Brown, “Physiology and Patho-Physiology of the Extra-Cellular Calcium-Sensing Receptor,” American Journal of Medicine, 1999, Vol. 106, No. 2, pp. 238-253. doi:10.1016/S0002-9343(98)00418-5
[21] D. A. Heath, “Clinical Manifestations of Abnormalities of the Calcium Sensing Receptor,” Clinical Endocrinology Vol. 48, No. 3, 1998, pp. 257-258.
[22] J. Tfelt-Hansen and E. M. Brown, “The Calcium-Sensing Receptor in Normal Physiology and Patho-Physiology,” Clinical Laboratory Sciences, Vol. 42, No. 1, 2005, pp. 35-70. doi:10.1080/10408360590886606

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