Hostname: page-component-6766d58669-vgfm9 Total loading time: 0 Render date: 2026-05-21T19:11:23.845Z Has data issue: false hasContentIssue false
  • English
  • Français

Predictors of post-thyroidectomy hypocalcaemia: a systematic and narrative review

Published online by Cambridge University Press:  10 June 2020

A E L McMurran Open the ORCID record for A E L McMurran [Opens in a new window] ,
R Blundell  and
V Kim
A E L McMurran*
Affiliation:
Department of Otolaryngology, St John's Hospital at Howden, Livingston, Scotland, UK
R Blundell
Affiliation:
School of Medicine, University of Dundee, Dundee, Scotland, UK
V Kim
Affiliation:
Department of Otolaryngology, Ninewells Hospital and Medical School, Dundee, Scotland, UK
*
Author for correspondence: Ms A E Louise McMurran, Department of Otolaryngology, St John's Hospital at Howden, Howden W Road, Livingston EH54 6PP, Scotland, UK E-mail: louisemcmurran@nhs.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Hypocalcaemia is the most common complication after total or completion thyroidectomy. This study assesses recent evidence on predictive factors for post-thyroidectomy hypocalcaemia in order to identify the patients affected and aid prevention.

Method

Two authors independently assessed articles and extracted data to provide a narrative synthesis. This study was an updated systematic search and narrative review regarding predictors of post-thyroidectomy hypocalcaemia using the Ovid Medline, Embase, Cochrane and Cinahl databases. Results were limited to papers published from January 2012 to August 2019.

Results

Sixty-three observational studies with a total of 210 401 patients met the inclusion criteria. The median incidence was 27.5 per cent for transient biochemical hypocalcaemia, 12.5 per cent for symptomatic hypocalcaemia and 2.2 per cent for permanent hypocalcaemia. The most frequent statistically significant predictor of hypocalcaemia was peri-operative parathyroid hormone level. Symptomatic hypocalcaemia and permanent hypocalcaemia were seen more frequently in patients undergoing concomitant neck dissection.

Conclusion

Many factors have been studied for their link to post-thyroidectomy hypocalcaemia, and this study assesses the recent evidence presented in each case.

Keywords

HypocalcemiaThyroidectomyPostoperative Complications

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 6 , June 2020 , pp. 541 - 552
Copyright
Copyright © JLO (1984) Limited, 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Ms A E L McMurran takes responsibility for the integrity of the content of the paper

The findings from an earlier version of this study were presented at the ENT Scotland Summer Meeting, 11 May 2018, Dunblane, Scotland, UK.

References

Bhattacharyya, N, Fried, MP. Assessment of the morbidity and complications of total thyroidectomy. Arch Otolarygol Head Neck Surg 2002;128:389–92CrossRefGoogle ScholarPubMed
The British Association of Endocrine and Thyroid Surgeons. Fifth National Audit Report 2017 http://www.baets.org.uk/wp-content/uploads/BAETS-Audit-National-Report-2017.pdf. Accessed June 16, 2018Google Scholar
Edafe, O, Antakia, R, Laskar, N, Uttley, L, Balasubramanian, SP. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg 2014;101:307–20CrossRefGoogle ScholarPubMed
Pellegriti, G, Frasca, F, Regalbuto, C, Squatrito, S, Vigneri, R. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol 2013;2013:965212CrossRefGoogle ScholarPubMed
James, BC, Mitchell, JM, Jeon, HD, Vasilottos, N, Grogan, RH, Aschebrook-Kilfoy, B. An update in international trends in incidence rates of thyroid cancer, 1973–2007. Cancer Causes Control 2018;29:465–73CrossRefGoogle ScholarPubMed
Perros, P, Boelaert, K, Colley, S, Evans, C, Evans, RM, Gerrard Ba, G et al. Guidelines for the management of thyroid cancer. Clin Endocrinol 2014;81(suppl 1):1–122CrossRefGoogle ScholarPubMed
The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised studies in Meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp Accessed June 16, 2018Google Scholar
Tan, VY, Lewis, SJ, Adams, JC, Martin, RM. Association of fascin-1 with mortality, disease progression and metastasis in carcinomas: a systematic review and meta-analysis. BMC Med 2013;11:52CrossRefGoogle ScholarPubMed
Liberati, A, Altman, DG, Tetzlaff, J, Mulrow, C, Gøtzsche, PC, Ioannidis, JP et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: exploration and elaboration. BMJ 2009;339:b2700CrossRefGoogle Scholar
Abdollahi, A, Nakhjavani, M, Alibakhshi, A, Mohammadifard, M. Is there any relationship between serum level of Vitamin D and postoperative hypocalcemia after total thyroidectomy? Biomed Pharmacol J 2017;10:207–211CrossRefGoogle Scholar
Al-Khatib, T, Althubaiti, AM, Althubaiti, A, Mosli, HH, Alwasiah, RO, Badawood, LM. Severe vitamin D deficiency: a significant predictor of early hypocalcemia after total thyroidectomy. Otolaryngol Head Neck Surg 2015;152:424–31CrossRefGoogle ScholarPubMed
Alparslan Yumun, HN, Erol, MF, Guler, K. Predictive value of parathormone level at skin closure for postoperative hypocalcemia. Chirurgia 2016;29:73–8Google Scholar
Al-Qahtani, A, Parsyan, A, Payne, R, Tabah, R. Parathyroid hormone levels 1 hour after thyroidectomy: an early predictor of postoperative hypocalcemia. Can J Surg 2014;57:237–40CrossRefGoogle Scholar
Bove, A, Di Renzo, RM, Palone, G, D'Addetta, V, Percario, R, Panaccio, P et al. Early biomarkers of hypocalcemia following total thyroidectomy. Int J Surg Oncol 2014;12:S202–4Google ScholarPubMed
Chapman, DB, French, CC, Leng, X, Browne, JD, Waltonen, JD, Sullivan, CA. Parathyroid hormone early percent change: an individualized approach to predict postthyroidectomy hypocalcemia. Am J Otolaryngol 2012;33:216–20CrossRefGoogle ScholarPubMed
Cherian, AJ, Ponraj, S, Gowri, SM, Ramakant, P, Paul, TV, Abraham, DT et al. The role of vitamin D in post-thyroidectomy hypocalcemia: still an enigma. Surgery 2016;159:532–8CrossRefGoogle ScholarPubMed
Cherian, AJ, Gowri, M, Ramakant, P, Paul, TV, Abraham, DT, Paul, MJ. The role of magnesium in post-thyroidectomy hypocalcemia. World J Surg 2016;40:881–8CrossRefGoogle ScholarPubMed
Chisthi, MM, Nair, RS, Kuttanchettiyar, KG, Yadev, I. Mechanisms behind post-thyroidectomy hypocalcemia: interplay of calcitonin, parathormone, and albumin-a prospective study. J Invest Surg 2017;30:217–25CrossRefGoogle ScholarPubMed
Edafe, O, Prasad, P, Harrison, BJ, Balasubramanian, SP. Incidence and predictors of post-thyroidectomy hypocalcaemia in a tertiary endocrine surgical unit. Ann R Coll Surg Engl 2014;96:219–23CrossRefGoogle Scholar
Garrahy, A, Murphy, MS, Sheahan, P. Impact of postoperative magnesium levels on early hypocalcemia and permanent hypoparathyroidism after thyroidectomy. Head Neck 2016;38:613–19CrossRefGoogle ScholarPubMed
Inversini, D, Rausei, S, Ferrari, CC, Frattini, F, Anuwong, A, Kim, HY et al. Early intact PTH (iPTH) is an early predictor of postoperative hypocalcemia for a safer and earlier hospital discharge: an analysis on 260 total thyroidectomies. Gland Surg 2016;5:522–8CrossRefGoogle ScholarPubMed
Kala, F, Sarici, IS, Ulutas, KT, Sevim, Y, Dogu, A, Sarigoz, T et al. Intact parathormone measurement 1 hour after total thyroidectomy as a predictor of symptomatic hypocalcemia. Int J Clin Exp Med 2015;8:18813–18Google Scholar
Karatzanis, AD, Ierodiakonou, DP, Fountakis, ES, Velegrakis, SG, Doulaptsi, MV, Prokopakis, EP et al. Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy. Head Neck 2018;40:1040–5CrossRefGoogle ScholarPubMed
Lang, BH, Yih, PC, Ng, KK. A prospective evaluation of quick intraoperative parathyroid hormone assay at the time of skin closure in predicting clinically relevant hypocalcemia after thyroidectomy. World J Surg 2012;36:1300–6CrossRefGoogle ScholarPubMed
Lang, BH, Wong, KP, Cowling, BJ, Fong, YK, Chan, DK, Hung, GK. Do low preoperative vitamin D levels reduce the accuracy of quick parathyroid hormone in predicting postthyroidectomy hypocalcemia? Ann Surg Oncol 2013;20:739–45CrossRefGoogle ScholarPubMed
Noureldine, SI, Genther, DJ, Lopez, M, Agrawal, N, Tufano, RP. Early predictors of hypocalcemia after total thyroidectomy: an analysis of 304 patients using a short-stay monitoring protocol. JAMA Otolaryngol Head Neck Surg 2014;140:1006–13CrossRefGoogle ScholarPubMed
Pisanu, A, Saba, A, Coghe, F, Uccheddu, A. Early prediction of hypocalcemia following total thyroidectomy using combined intact parathyroid hormone and serum calcium measurement. Langenbecks Arch Surg 2013;398:423–30CrossRefGoogle ScholarPubMed
Pradeep, PV, Ramalingam, K, Jayashree, B. Post total thyroidectomy hypocalcemia: a novel multi-factorial scoring system to enable its prediction to facilitate an early discharge. J Postgrad Med 2013;59:4–8CrossRefGoogle ScholarPubMed
Raffaelli, M, De Crea, C, D'Amato, G, Moscato, U, Bellantone, C, Carrozza, C et al. Post-thyroidectomy hypocalcemia is related to parathyroid dysfunction even in patients with normal parathyroid hormone concentrations early after surgery. Surgery 2016;159:78–84CrossRefGoogle ScholarPubMed
Salinger, EM, Moore, JT. Perioperative indicators of hypocalcemia in total thyroidectomy: the role of vitamin D and parathyroid hormone. Am J Surg 2013;206:876–81CrossRefGoogle ScholarPubMed
Seo, ST, Chang, JW, Jin, J, Lim, YC, Rha, K, Koo, BS. Transient and permanent hypocalcemia after total thyroidectomy: early predictive factors and long-term follow-up results. Surgery 2015;158:1492–9CrossRefGoogle ScholarPubMed
Sung, TY, Lee, YM, Yoon, JH, Chung, KW, Hong, SJ. Importance of the intraoperative appearance of preserved parathyroid glands after total thyroidectomy. Surg Today 2016;46:356–62CrossRefGoogle ScholarPubMed
White, MG, James, BC, Nocon, C, Nagar, S, Kaplan, EL, Angelos, P et al. One-hour PTH after thyroidectomy predicts symptomatic hypocalcemia. J Surg Res 2016;201:473–9CrossRefGoogle ScholarPubMed
Danan, D, Shonka, DC Jr. Preoperative vitamin D level as predictor of post-thyroidectomy hypocalcemia in patients sustaining transient parathyroid injury. Head Neck 2017;39:1378–81CrossRefGoogle ScholarPubMed
Hammerstad, SS, Norheim, I, Paulsen, T, Amlie, LM, Eriksen, EF. Excessive decrease in serum magnesium after total thyroidectomy for Graves' disease is related to development of permanent hypocalcemia. World J Surg 2013;37:369–75CrossRefGoogle ScholarPubMed
Mehrvarz, S, Mohebbi, HA, Kalantar Motamedi, MH, Khatami, SM, Rezaie, R, Rasouli, HR. Parathyroid hormone measurement in prediction of hypocalcaemia following thyroidectomy. J Coll Physicians Surg Pak 2014;24:82–7Google ScholarPubMed
Islam, MS, Sultana, T, Paul, D, Huq, AH, Chowdhury, AA, Ferdous, C et al. Intraoperative serum parathyroid hormone level is an indicator of hypocalcaemia in total thyroidectomy patients. Bangladesh Med Res Counc Bull 2012;38:84–9CrossRefGoogle ScholarPubMed
Nair, CG, Babu, MJC, Menon, R, Jacob, P. Hypocalcaemia following total thyroidectomy: an analysis of 806 patients. Indian J of Endocrinol Metab 2013;17:298–303CrossRefGoogle ScholarPubMed
Aqtashi, B, Ahmad, N, Frotzler, A, Bähler, S, Linder, T, Müller, W. Risk factors for hypocalcaemia after completion hemithyroidectomy in thyroid cancer. Swiss Med Wkly 2017;147:w14513Google ScholarPubMed
Lecerf, P, Orry, D, Perrodeau, E, Lhommet, C, Charretier, C, Mor, C et al. Parathyroid hormone decline 4 hours after total thyroidectomy accurately predicts hypocalcemia. Surgery 2012;152:863–8CrossRefGoogle ScholarPubMed
Puzziello, A, Gervasi, R, Orlando, G, Innaro, N, Vitale, M, Sacco, R. Hypocalcaemia after total thyroidectomy: could intact parathyroid hormone be a predictive factor for transient postoperative hypocalcemia? Surgery 2015;157:344–8CrossRefGoogle ScholarPubMed
Lee, GH, Ku, YH, Kim, HI, Lee, MC, Kim, MJ. Vitamin D level is not a predictor of hypocalcemia after total thyroidectomy. Langenbecks Arch Surg 2015;400:617–22CrossRefGoogle Scholar
Luo, H, Yang, H, Zhao, W, Wei, T, Su, A, Wang, B et al. Hypomagnesemia predicts postoperative biochemical hypocalcemia after thyroidectomy. BMC Surg 2017;17:62CrossRefGoogle ScholarPubMed
Kobayashi, S, Minami, S, Yamanouchi, K, Hayashida, N, Sakimura, C, Eguchi, S. The preoperative prediction of postoperative symptomatic hypocalcemia in patients with Graves' disease. Acta Med Nagasaki 2015;60:1–5Google Scholar
Reddy, AC, Chand, G, Sabaretnam, M, Mishra, A, Agarwal, G, Agarwal, A et al. Prospective evaluation of intra-operative quick parathyroid hormone assay as an early predictor of post thyroidectomy hypocalcaemia. Int J Surg 2016;34:103–8CrossRefGoogle ScholarPubMed
Docimo, G, Ruggiero, R, Casalino, G, Del Genio, G, Docimo, L, Tolone, S. Risk factors for postoperative hypocalcemia. Updates Surg 2017;69:255–60CrossRefGoogle ScholarPubMed
Kaleva, AI, Hone, RW, Tikka, T, Al-Lami, A, Balfour, A, Nixon, IJ. Predicting hypocalcaemia post-thyroidectomy: a retrospective audit of results compared to a previously published nomogram in 64 patients treated at a district general hospital. Clin Otolaryngol 2017;42:442–6CrossRefGoogle Scholar
Paliogiannis, P, Pisano, IP, Marrosu, A, Pulighe, F, Fara, P, Biddau, C et al. Accidental parathyroidectomy as a risk factor for postoperative hypocalcemia in thyroid surgery. Acta Medica Mediterranea 2014;30:91–4Google Scholar
Tongol, MC, Mirasol, R. Incidence and risk factors for post-thyroidectomy hypocalcemia. JAFES 2016;31:30–6CrossRefGoogle Scholar
Sheahan, P, Mehanna, R, Basheeth, N, Murphy, MS. Is systematic identification of all four parathyroid glands necessary during total thyroidectomy? A prospective study. Laryngoscope 2013;123:2324–8CrossRefGoogle ScholarPubMed
Vanderlei, FAB, Vieira, JGH, Hojaij, FC, Cervantes, O, Kunii, IS, Ohe, MN et al. Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy. Arq Bras Endocrinol Metabol 2012;56:168–72CrossRefGoogle ScholarPubMed
Falch, C, Hornig, J, Senne, M, Braun, M, Konigsrainer, A, Kirschniak, A et al. Factors predicting hypocalcemia after total thyroidectomy - A retrospective cohort analysis. Int J Surg 2018;55:46–50CrossRefGoogle ScholarPubMed
Chew, C, Li, R, Ng, MK, Chan, STF, Fleming, B. Incidental parathyroidectomy during total thyroidectomy is not a direct cause of post-operative hypocalcaemia. ANZ J Surg 2018;88:158–61CrossRefGoogle Scholar
Falcone, TE, Stein, DJ, Jumaily, JS, Pearce, EN, Holick, MF, McAneny, DB et al. Correlating pre-operative vitamin D status with post-thyroidectomy hypocalcemia. Endocr Pract 2015;21:348–54CrossRefGoogle ScholarPubMed
Griffin, TP, Murphy, MS, Sheahan, P. Vitamin D and risk of postoperative hypocalcemia after total thyroidectomy. JAMA Otolaryngol Head Neck Surg 2014;140:346–51CrossRefGoogle ScholarPubMed
Kalyoncu, D, Gonullu, D, Gedik, ML, Er, M, Kuroglu, E, Igdem, AA et al. Analysis of the factors that have an effect on hypocalcemia following thyroidectomy. Turk J Surg 2013;29:171–6CrossRefGoogle ScholarPubMed
Merchavy, S, Marom, T, Forest, VI, Hier, M, Mlynarek, A, McHugh, T et al. Comparison of the incidence of postoperative hypocalcemia following total thyroidectomy vs completion thyroidectomy. Otolaryngol Head Neck Surg 2015;152:53–6CrossRefGoogle ScholarPubMed
Chereau, N, Vuillermet, C, Tilly, C, Buffet, C, Trésallet, C, du Montcel, ST et al. Hypocalcemia after thyroidectomy in patients with a history of bariatric surgery. Surg Obes Relat Dis 2017;13:484–90CrossRefGoogle ScholarPubMed
Christou, N, Blanchard, C, Pattou, F, Volteau, C, Brunaud, L, Hamy, A et al. Advanced age does not increase morbidity after total thyroidectomy. Result of a prospective study. Am J Surg 2019;217:767–71CrossRefGoogle Scholar
De Palma, M, Rosato, L, Zingone, F, Orlando, G, Antonino, A, Vitale, M et al. Post-thyroidectomy complications. The role of the device: bipolar vs ultrasonic device: Collection of data from 1,846 consecutive patients undergoing thyroidectomy. Am J Surg 2016;212:116–21CrossRefGoogle ScholarPubMed
Ozogul, B, Akcay, MN, Akcay, G, Bulut, OH. Factors affecting hypocalcaemia following total thyroidectomy: a prospective study. Eurasian J Med 2014;46:15–21CrossRefGoogle ScholarPubMed
Mascarella, MA, Forest, VI, Nhan, C, Leboeuf, R, Tamilia, M, Mlynarek, AM et al. Seasonal difference in postthyroidectomy hypocalcemia: a Montreal-based study. Otolaryngol Head Neck Surg 2016;154:263–7CrossRefGoogle ScholarPubMed
Abdel-Halim, CN, Rejnmark, L, Nielsen, VE. Post-operative parathyroid hormone can be used as a predictor of normocalcaemia after total thyroidectomy. Dan Med J 2015;62:A5157Google ScholarPubMed
Kim, JP, Park, JJ, Son, HY, Kim, RB, Kim, HY, Woo, SH. Effectiveness of an i-PTH measurement in predicting post thyroidectomy hypocalcemia: prospective controlled study. Yonsei Med J 2013;54:637–42CrossRefGoogle ScholarPubMed
Seo, GH, Chai, YJ, Choi, HJ, Lee, KE. Incidence of permanent hypocalcaemia after total thyroidectomy with or without central neck dissection for thyroid carcinoma: a nationwide claim study. Clin Endocrinol (Oxf) 2016;85:483–7CrossRefGoogle ScholarPubMed
Ambe, PC, Bromling, S, Knoefel, WT, Rehders, A. Prolonged duration of surgery is not a risk factor for postoperative complications in patients undergoing total thyroidectomy: a single center experience in 305 patients. Patient Saf Surg 2014;8:45CrossRefGoogle Scholar
Blanchard, C, Pattou, F, Brunaud, L, Hamy, A, Dahan, M, Mathonnet, M, et al. Randomized clinical trial of ultrasonic scissors versus conventional haemostasis to compare complications and economics after total thyroidectomy (FOThyr). BJS open 2017;1:2–10CrossRefGoogle Scholar
Blanchard, C, Bannani, S, Pattou, F, Brunaud, L, Hamy, A, Christou, N et al. Impact of body mass index on post-thyroidectomy morbidity. Head Neck 2019;41:2952–9CrossRefGoogle ScholarPubMed
Godazandeh, G, Kashi, Z, Godazandeh, F, Tayebi, P, Bijani, A. Influence of thyroidectomy on postoperative serum calcium level regarding serum vitamin D status. A prospective study. Caspian J Intern Med 2015;6:72–6Google ScholarPubMed
Lee, DY, Cha, W, Jeong, WJ, Ahn, SH. Preservation of the inferior thyroidal vein reduces post-thyroidectomy hypocalcemia. Laryngoscope 2014;124:1272–7CrossRefGoogle ScholarPubMed
Miah, MS, Mahendran, S, Mak, C, Leese, G, Smith, D. Pre-operative serum alkaline phosphatase as a predictive indicator of post-operative hypocalcaemia in patients undergoing total thyroidectomy. J Laryngol Otol 2015;129:1128–32CrossRefGoogle ScholarPubMed
Nhan, C, Dolev, Y, Mijovic, T, Rivera, JA, Kallai-Sanfacon, MA, Mlynarek, AM et al. Vitamin D deficiency and the risk of hypocalcemia following total thyroidectomy. J Otolaryngol Head Neck Surg 2012;41:401–6Google ScholarPubMed