Post-Thyroidectomy Hypocalcemia: Timing of Discharge Based on Serum Calcium Levels
DOI:
https://doi.org/10.17140/SROJ-2-111Keywords:
Surgery, Calcium, Thyroid glandAbstract
Purpose: The study concerns about the evaluation of Calcium serum levels in patients who underwent total thyroidectomy. Our previous experience underlined how patients who had levels of serum Calcium more than 9 mg/dl at the first day after surgery, did not show Hypocalcemia in the next days, so that this value could be considered a good cut-off for the decision of an early discharge. With regards to this experience, the aim of our current study was to confirm the effective feasibility of an early discharge based on the levels of serum Calcium at the first post-operative day.
Patients and Methods: Our study included 102 consecutive patients (82 F; 20 M, age with a range between 14-78 year sold, average 52.6) that were submitted to total thyroidectomy in the years 2010 to 2014, performed by the same operator and all done with sutureless technique (Ligasure precise©) We classify hypocalcemia, according to their normal range (8.6 to 10.4 mg/dl), in mild (not less than 7.6 mg/dL), moderate (between 7.5 mg/dL and 7 mg/dL) and severe (less than 7 mg/dL) We classified the normal range of serum Calcium between 8.6 mg/dl and 10.4 mg/dl. Patients that showed levels of serum Calcium under this limit (<8.6 mg/dl) were treated with 6 fials of Gluconate Calcium 40 mEq in 500 ml of saline solution NaCl 0.9% i.v. (one per day), until the return to the normal range. Patients who had serum Calcium levels more than 9 mg/dl at the first post-operative days, and did not have other complications, were discharged at the same day and revaluated after 7 days.
Discussion and Conclusion: Moreover our study has been useful to confirm what we observed in the previous experience, that levels of serum Calcium more than 9 mg/dl at the first post operative day can be considered a feasible cut-off to exclude the appearance of hypocalcaemia in future. Therefore, according to our results, we assume to propose an early discharge for the patients who have serum Calcium levels more than 9 mg/dl, asking them to come back for controls one week after discharge.
References
Pezzolla A, Docimo G, Ruggiero R, et al. Incidentalthyroid carcinoma: a multicentric experience. Recenti Progressi in Me-dicina. 2010; 101(5): 194-198.
Parmeggiani U, Avenia N, De Falco M, et al. Major complica-tions in thyroid surgery: utility of bipolar vessel sealing (Ligas-ure Precise). G Chir. 2005; 26(10): 387-394.
Sciumè C, Geraci G, Pisello F, et al. Complications in thyroid surgery: symptomatic post-operative hypoparathyroidism inci-dence, surgical technique, and treatment. Ann Ital Chir. 2006; 77(2):115-22.
Doran HE, Palazzo F. Ambulatory thyroid surgery: do the risks overcome the benefits? Presse Med. 2014; 43(3): 291-296. doi: 10.1016/j.lpm.2014.01.001
Parmeggiani D, De Falco M, Avenia N, et al. NIM vs Neu-rosign in nervesparingtotalthyroidectomy. Multicentric experi-ence. Annali Italiani di Chirurgia. 2012; 83(3): 233-238.
Docimo G, Avenia N, Ragusa M, et al. Non recurrent inferior laryngeal nerve: Our surgical experience. Clinica Terapeutica. 2009; 160(5): 347-349.
Roh JL, Park CI. Routine oral calcium and vitamin D supple-mentation fo prevention of hypocalcemia after total thyroidec-tomy. Am J Surg. 2006; 192: 675-678.
Del Rio P, Iapichino G, De Simone B, Bezer L, Arcuri M, Sianesi M. Is it possible to identify a risk factor condition of hypocalcemia in patients candidates to thyroidectomy for benign disease? Ann Ital Chir. 2010; 81(6): 397-401.
Costanzo M, Marziani A, Condorelli F, Migliore M, Canniz-zaro MA. Post-thyroidectomy hypocalcemic syndrome: pre-dictive value of early PTH. Preliminary results. Ann Ital Chir. 2010; 81(4): 301-305.
Pisaniello D, Parmeggiani D, Piatto A, et al. Which therapy to prevent post-thyroidectomy hypocalcemia? G Chir. 2005; 26(10): 357-361.
De Falco M, Oliva G, Ragusa M, et al. Surgical treatment of differentiated thyroid carcinoma: a retrospective study. G Chir. 2008; 29(4): 152-158.
Materazzi G, Dionigi G, Berti P, et al. One day thyroid sur-gery: restrospective analysis of safety and patient satisfaction on a consecutive series of 1.571 cases over a three-year period. Eur Surg Res. 2007; 39: 182-188.
Dedivitis RA, Pfuetzenreiter JR, Castro MAF, Denardin OVP. Analysis of safety of short-stay thyroid surgery. Acta Oto-rhinolaryngologica Italica. 2009; 29: 326-330.
Sperlongano P, Sperlongano S, Foroni F, et al. Postoperativehypocalcemia: assessment timing. Int J Surg. 2014; 12(Suppl 1): S95-S97 doi: 10.1016/j.ijsu.2014.05.042
Qahtani ALA, Parsyan A, Payne R, Tabah R. Parathyroid hormone levels 1 hour after thyroidectomy: an early predictor of postoperative hypocalcemia. Can J Surg. 2014; 57(4): 237-240.
Seo ST, Chang JW, Jin J, Lim YC, Rha KS, Koo BS. Transient and permanent hypocalcemia after total thyroidectomy: Early predictive factors and long-term follow-up results. Surgery. 2015. doi: 10.1016/j.surg.2015.04.041
De Pasquale L, Sartori PV, Vicentini L, et al. Necessity of therapy for post-thyroidectomy hypocalcaemia: a multi-centre experience. Langenbecks Arch Surg. 2015; 400(3): 319-24. doi: 10.1007/s00423-015-1292-0
Lorente-Poch L, Sancho JJ, Muñoz-Nova JL, Sánchez-Velázquez P, Sitges-Serra A. Defining the syndromes of parathyroid failure after total thyroidectomy. Gland Surg. 2015; 4(1): 82-90.
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