Investigation of the Frequency and Risk Factors of Hypocalcemia after Thyroid Surgery in Shahid Beheshti Hospital, Babol, during the Years 2016 to 2019

Nikbakhsh, N; Vaeze, R; Kamali Ahangar, S; Gholinia, H

Investigation of the Frequency and Risk Factors of Hypocalcemia after Thyroid Surgery in Shahid Beheshti Hospital, Babol, during the Years 2016 to 2019

Authors

N Nikbakhsh ¹

R Vaeze ²

S Kamali Ahangar ³

H Gholinia ⁴

¹ Professor of Thoracic Surgery, Babol University of Medical Sciences, Cancer Research Center, Ayatollah Rouhani Hospital, Tehran, Iran

² General Physician, Student Research Committee, Babol University of Medical Sciences

³ Research Expert, Clinical Research Development Unit, Babol University of Medical Sciences, Shahid Beheshti Hospital, Babol

⁴ Master of Science in Biostatistics, Clinical Research Development Unit, Babol University of Medical Sciences, Shahid Beheshti Hospital, Babol

Abstract

Introduction & Objective: Hypocalcemia is one of the severe complications of thyroid surgery. This complication usually occurs after damage to the parathyroid glands during surgery. This study was conducted with the aim of investigating the frequency and risk factors of hypocalcemia after thyroid surgery in Shahid Beheshti Hospital, Babol (2016-2019). Materials & Methods: In this cross-sectional study, 160 patients who underwent thyroid surgery at Shahid Beheshti Hospital in Babol between 2015 and 2017 were included in the study. The amount of serum calcium immediately after surgery, on the first day after surgery and in case of hypocalcemia on the 4th day after surgery and the year of operation were completed by the project managers from the patients' files. The data was analyzed with SPSS V.22 software. Descriptive indices, Chi-square tests, and logistic regression were used. P value less than 0.05 was considered significant. Results: The average age was 45.07 ± 15.12 years and the median was 46.5 years. In examining the relationship (one-variable) between the variables of gender, thyroid malignancy, type of malignancy and type of surgery with hypocalcemia, only the type of surgery showed a significant relationship with hypocalcemia, so that the lowest amount of hypoglycemia was related to lobectomy (P = 0.004). Using logistic regression (in multivariate mode), the factors affecting hypocalcemia were evaluated. Finally, it was found that people with complete thyroidectomy have more than 3 times the chance of hypocalcemia compared to lobectomy (P = 0.004 and OR = 3.70). Conclusions: According to the results, the frequency of hypocalcemia was similar to other studies conducted inside and outside the country, and total thyroidectomy surgery increases the chance of hypocalcemia.

Keywords

Hypocalcemia

Risk Factors

Thyroidectomy

1. Karamanakos SN, Markou KB, Panagopoulos K, Karavias D, Vagianos CE, Scopa CD, et al. Complications and risk factors related to the extent of surgery in thyroidectomy. Results from 2,043 procedures. Hormones (Athens, Greece). 2010; 9(4): 318-25.

2. Ho TW, Shaheen AA, Dixon E, Harvey A. Utilization of thyroidectomy for benign disease in the United States: a 15-year population-based study. American journal of surgery. 2011; 201(5): 570-4.

3. Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, et al. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World journal of surgery. 1998; 22(7): 718-24.

4. Costanzo M, Marziani A, Condorelli F, Migliore M, Cannizzaro MA. Post-thyroidectomy hypocalcemic syndrome: predictive value of early PTH. Preliminary results. Annali italiani di chirurgia. 2010; 81(4):
301-5.

5. Kashi Z, Ghodazandeh GA, Akha O, Hasannia S. Complications of Total and Subtotal Thyroidectomy in Patients Referring to an Academic and a Private Hospital in Sari, Iran. Journal of Mazandaran University of Medical Sciences. 2013; 23(106):
86-93.

6. Reeve T, Thompson NW. Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World journal of surgery. 2000; 24(8):
971-5.

7. Stack BC, Jr., Bimston DN, Bodenner DL,
Brett EM, Dralle H, Orloff LA, et al. AACE/ACE disease state clinical review: postoperative hypoparathyroidism - definitions and management. Endocrine practice: official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2015; 21(6): 674-85.

8. Puzziello A, Rosato L, Innaro N, Orlando G, Avenia N, Perigli G, et al. Hypocalcemia following thyroid surgery: incidence and risk factors. A longitudinal multicenter study comprising 2,631 patients. Endocrine. 2014; 47(2): 537-42.

9. Gulcelik MA, Dogan L, Akgul GG, Guven EH, Ersoz Gulcelik N. Completion Thyroidectomy: Safer than Thought. Oncology research and treatment. 2018; 41(6): 386-90.

10. Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. Systematic review and
meta-analysis of predictors of post-thyroidectomy hypocalcaemia. The British journal of surgery. 2014; 101(4): 307-20.

11. Sokouti M, Feizi E. Preventing Role of Parathyroid Autotransplantation on Permanent Hypocalcaemia upon Total Thyroidectomy for Thyroid Disease in Imam Reza Hospital, Tabriz. Journal of Ardabil University of Medical Sciences. 2011; 11(4):
337-44.

12. Chindavijak S. Prediction of hypocalcemia in postoperative total thyroidectomy using single measurement of intra-operative parathyroid hormone level. Journal-Medical Association of Thailand. 2007; 90(6): 1167.

13. Chow T, Chu W, Lim B, Kwok S. Outcomes and complications of thyroid surgery: retrospective study. Hong Kong Medical Journal = Xianggang yi xue za zhi. 2001; 7(3): 261-5.

14. Chaudhary IA, Samiullah RM, Mallhi AA. Complications of thyroid surgery: a five year experience at fauji foundation hosp., Rawalpindi. Pak J Surg. 2006; 22(3): 134-7.

15. McMurran AEL, Blundell R, Kim V.
Predictors of post-thyroidectomy hypocalcaemia: a systematic and narrative review. The
Journal of laryngology and otology. 2020; 134(6): 541-52.

16. Eismontas V, Slepavicius A, Janusonis V, Zeromskas P, Beisa V, Strupas K, et al. Predictors of postoperative hypocalcemia occurring after a total thyroidectomy: results of prospective multicenter study. BMC surgery. 2018; 18(1): 55.

17. Manatakis DK, Balalis D, Soulou VN, Korkolis DP, Plataniotis G, Gontikakis E. Incidental parathyroidectomy during total thyroidectomy: risk factors and consequences. International journal of endocrinology. 2016; 2016.

18. Sousa Ade A, Salles JM, Soares JM, Moraes GM, Carvalho JR, Savassi-Rocha PR. Predictors factors for post-thyroidectomy hypocalcaemia. Revista do Colegio Brasileiro de Cirurgioes. 2012; 39(6):
476-82.