World Congress on Thyroid Cancer 4.0
July 29 – August 1, 2021
WCTC3.5 Steering Committee:
Rocco Bellantone, Co-Chair
Celestino Lombardi, Co-Chair
Gregory W. Randolph, MD
Bryan McIver, MD
Jeremy Freeman, MD
Ian J. Witterick, MD
Ashok R. Shaha, MD
Jatin P. Shah, MD
OP34 – Risk factors for postoperative hypocalcemia. A retrospective study in a Community Hospital of La Plata, Argentina
Zund, Santiago1, Stoppini Gallagher, Maximiliano1, Pérez Irigoyen, Claudio2
1 Division of Head & Neck Surgery, Hospital Español, La Plata, Buenos Aires, Argentina
2 Department of General Surgery, Hospital Español, La Plata, Buenos Aires, Argentina
Background/ Purpose: Hypocalcemia is the most common complication after total thyroidectomy (TT). Nevertheless, some preoperative predictive factors of this event are still unclear. The aim of this study was to evaluate the role of risk factors for hypocalcemia after TT, and secondary the utility of intact parathyroid hormone (PTHi) for early discharge.
Methods: Retrospective study of patients that underwent TT between 2008 and 2016. Same surgeon, same team, same Institution. Hypocalcemia was defined as a calcium <8 mg/dl or ionic calcium <4 mg/dl after TT. Permanent hypocalcemia if these values were present or requiring calcium/vitamin D supplementation for more than a year. PTHi was checked postoperative. Statistical analysis: SPSS Windows 19.0.
Results: A total of 281 patients underwent TT. Histology revealed benign and malignant disease in 64.5% and 35.5% of cases, respectively. Central-compartment neck dissection (CCND) was performed in 33 subjects (11.7%), with 14 (42%) therapeutic dissections, and 19 (48%), prophylactic lymphadenectomies. Laboratory asymptomatic hypocalcemia was observed in 46 (16.4%) patients; symptomatic hypocalcemia occurred in 34 (12.1%). Transient hypocalcemia (laboratory plus symptomatic) was observed in 80 (28.4%) patients, while permanent hypocalcemia occurred only in three patients (1%) that underwent TT with CCND for thyroid cancer. Parathyroid gland reimplantation was performed in 35.2% (99) of the cases. No parathyroid glands were found on the specimens. On univariate analysis, malignant pathology (p< 0.001), CCND (p< 0.05), female gender (p< 0.001), PTH?10 pg/ml (p were factors that significantly increased the risk of developing symptomatic hypocalcemia. Regarding asymptomatic hypocalcemia,……, were risk factors.
Discussion and Conclusion: Cancer pathology, CCND and PTHi?10 pg/ml were predictive factors of symptomatic and laboratory hypocalcemia. Postoperative PTHi levels >20 pg/ml were safe for early discharge. The use of this cut-off might avoid unnecessary extensions of hospitalization.
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