Study of Effectiveness of Serum Phosphate as a Predictor of Temporary Hypocalcaemia Following Total Thyroidectomy
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ORIGINAL ARTICLE
Study of Effectiveness of Serum Phosphate as a Predictor of Temporary Hypocalcaemia Following Total Thyroidectomy Nedumparambil Sukumaran Sreekanth 1 Received: 14 May 2019 / Accepted: 26 March 2020 # Association of Surgeons of India 2020
Abstract Background Hypocalcaemia is the commonest complication following total thyroidectomy and is mainly due to parathyroid insufficiency. Measurement of serum calcium and PTH levels, post-thyroidectomy, is being used for predicting hypocalcaemia. PTH is an expensive test, not easily available in all hospitals. Since serum phosphate responds quickly to the change in PTH levels and is inexpensive and easily available, the effectiveness of serum phosphate in predicting the post-thyroidectomy hypocalcaemia was studied. Aim To find out if the serum phosphate levels help in predicting temporary hypocalcaemia developing in patients undergoing total thyroidectomy. Materials and Methods This was a prospective cross-sectional study of 118 patients who underwent total thyroidectomy, at Amrita Institute of Medical Sciences, Kochi, from June 2014 to June 2016. Patients had serum calcium and phosphate measured pre-operatively, on the evening of surgery (day 0), on the morning of day 1 and over the following week until discharge. Results Out of 118 patients, 104 (88.1%) were females and 14 (11.9%) were males. Thirty-seven (31.4%) patients developed biochemical hypocalcaemia (< 7.8 mg/dL) out of whom, 31 were symptomatic. Thirty-six patients (30.5%) developed treatment requiring symptomatic hypocalcaemia, out of whom, 5 did not have a drop in serum calcium levels. Temporary hypocalcaemia was seen in 42 (35.6%) patients. Out of 118 patients, 46 (38.9%) had a rise in serum phosphate. Early hyperphosphataemia was seen in 44 patients. Out of the 42 patients who developed temporary hypocalcaemia, 29 of them had a day 1 hyperphosphataemia and 33 had early hyperphosphataemia. Most of the patients who developed hypocalcaemia (15 patients) did so on the second post-operative day. The change in mean values of serum phosphate from baseline pre-operative value to day 0 and to day 1 was found to be significant in those patients who developed hypocalcaemia on day 2. Conclusion Serum phosphate can be used as a reliable predictor of post-thyroidectomy hypocalcaemia which would help in the safe early discharge of patients. Keywords Total thyroidectomy . Temporary hypocalcaemia . Hypoparathyroidism . Serum phosphate . PTH . Hyperphosphataemia
Background The thyroid is a gland of internal secretion and a unique site of several common diseases susceptible to medical or surgical treatments, or a combination of both. Thyroid surgery is one of the Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12262-020-02160-8) contains supplementary material, which is available to authorized users. * Nedumparambil Sukumaran Sreekanth [email protected] 1
Daya General Hospital and Specialty Surgical Centre, Thrissur, Kerala 680022, India
most commonly perfor
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