CLINICAL EVALUATION OF HYPOCALCEMIA AFTER THYROIDECTOMY
Main Article Content
Keywords
Parathyroid, serum calcium, thyroid gland, autotransplantation, proper anatomical knowledge.
Abstract
To estimate the incidence of hypocalcemia after total thyroidectomy also in relation with various pathological thyroid conditions and timing of presentation of hypocalcemia.
The aim of the study was to estimate the incidence of hypocalcemia after total thyroidectomy as post thyroidectomy hypocalcemia is a common complication and if not timely untreated or follow up leading to serious conditions to patients.
Methods: The Prospective observational study was done in patients who admitted in General surgery ward of our department for various Thyroid pathological conditions with 49 patients undergoing total thyroidectomy. A proforma will be used to collect information and estimate the incidence of post total thyroidectomy hypocalcemia with serial monitoring of serum calcium, with observation of signs and symptoms of hypocalcemia.
Result and Discussion: In this study, 49 patients were included. From the present study the incidence of hypocalcemia is 32.6%. Thyroid diseases are found more common in female 87.8%, with post thyroidectomy hypocalcemia seeing more in older age group 62% in (45-60) years comparing to younger age group. In relation to pre op indications of thyroidectomy with outcomes of hypocalcemia our study shows increased incidence of hypocalcemia in malignancy 57% of 100% and Grave‘s disease 50% out of 100%, MNG 26% out of 100% . Parathyroid gland is the most significant factor for post thyroidectomy hypocalcemia so careful identification, preservation is important and if devascularized or injured to gland autotransplantation of gland should be done.
Conclusion: The incidence of hypocalcemia is 32.6% in my study with more incidence found in older age, malignant lesion, Grave‘s disease, female sex. x Parathyroid glands identification and preservation plays key role in post thyroidectomy hypocalcemia.
References
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22. Sonkhya N, Agarwal S, Choudhary MP, Gupta N. Serial Estimation of Serum Calcium and Ionic Calcium Level for Early Detection of Hypocalcemia After Total/Completion Thyroidectomy. Indian J Otolaryngol Head Neck Surg. 2023 Dec;75(4):3493-3496. doi: 10.1007/s12070-023-04031-6. Epub 2023 Jul 1. PMID: 37974829; PMCID: PMC10645760. [22]
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24. Walsh SR, Kumar B, Coveney EC. Serum calcium slope predicts hypocalcaemia following thyroid surgery. Int J Surg. 2007 Feb;5(1):41-4. doi: 10.1016/j.ijsu.2006.03.006. Epub 2006 May 23. PMID: 17386914. [24]
25. Lee YH, Liu Z, Zheng L, Qiu J, Sang J, Guan W. The Rate of Postoperative Decline in Parathyroid Hormone Levels Can Predict Symptomatic Hypocalcemia Following Thyroid Cancer Surgery with Neck Lymph Node Dissection. Nutr Cancer. 2025;77(1):1-8. doi: 10.1080/01635581.2024.2401179. Epub 2024 Sep 23. PMID: 39313935. [25]
26. Lam A, Kerr PD. Parathyroid hormone: an early predictor of postthyroidectomy hypocalcemia. Laryngoscope. 2003 Dec;113(12):2196-200. doi: 10.1097/00005537-200312000-00029. PMID: 14660927. [26]
27. AlQahtani A, Parsyan A, Payne R, Tabah R. Parathyroid hormone levels 1 hour after thyroidectomy: an early predictor of postoperative hypocalcemia. Can J Surg. 2014 Aug;57(4):237-40. doi: 10.1503/cjs.008013. PMID: 25078927; PMCID: PMC4119114. [27]
28. Soon PS, Magarey CJ, Campbell P, Jalaludin B. Serum intact parathyroid hormone as a predictor of hypocalcaemia after total thyroidectomy. ANZ J Surg. 2005 Nov;75(11):977-80. doi: 10.1111/j.1445-2197.2005.03593.x. PMID: 16336392. [28]
29. Semanate F, Tarupi W, Fernandez Trokhimtchouk T, Palacios C, Jaramillo O. The Role of Parathyroid Hormone Level as a Predictor of Hypocalcemia After Total Thyroidectomy for Thyroid Cancer: A Cross-Sectional Study. Cureus. 2025 Feb 12;17(2):e78897. doi: 10.7759/cureus.78897. PMID: 40091995; PMCID: PMC11908629.[29]
30. Maheshwari M, Khan IA. Risk Factors for Transient and Permanent Hypoparathyroidism Following Thyroidectomy: A Comprehensive Review. Cureus. 2024 Aug 9;16(8):e66551. doi: 10.7759/cureus.66551. PMID: 39258042; PMCID: PMC11383864.[30]
31. Trupka A, Sienel W. Simultane Autotransplantation von Nebenschilddrüsengewebe im Rahmen der totalen Thyreoidektomie
32. parathyroid gland during thyroidectomy in benign thyroid disease minimizes the risk of permanent hypoparathyroidism]. Zentralbl Chir. 2002 May;127(5):439-42. German. doi: 10.1055/s-2002-31974. PMID: 12058305.
33. Barczyński M, Gołkowski F, Nawrot I. Parathyroid transplantation in thyroid surgery. Gland Surg. 2017 Oct;6(5):530-536. doi: 10.21037/gs.2017.06.07. PMID: 29142845; PMCID: PMC5676165.[32]
34. Lahey FH. The transplantation of parathyroids in partial thyroidectomy. Surg Gynecol Obstet. 1926;62:508–9. [33]
35. Zedenius J, Wadstrom C, Delbridge L. Routine autotransplantation of at least one parathyroid gland during total thyroidectomy may reduce permanent hypoparathyroidism to zero. Aust N Z J Surg. 1999 Nov;69(11):794-7. doi: 10.1046/j.1440-1622.1999.01697.x. PMID: 10553968. [34]
36. Lo CY. Parathyroid autotransplantation during thyroidectomy. ANZ J Surg. 2002 Dec;72(12):902-7. doi: 10.1046/j.1445-2197.2002.02580.x. PMID: 12485231. [35]
37. Olson JA Jr, DeBenedetti MK, Baumann DS, Wells SA Jr. Parathyroid autotransplantation during thyroidectomy. Results of long-term follow-up. Ann Surg. 1996 May;223(5):472-8; discussion 478-80. doi: 10.1097/00000658- 199605000-00003. PMID: 8651738; PMCID: PMC1235165. [36]
38. Calcium as a predictor of hypocalcemic symptoms post total thyroidectomy. Osteoporos Int. 2019 Dec;30(12):2495-2504. doi: 10.1007/s00198-019-05040-4. Epub 2019 Aug 28. PMID: 31463588.[37]
39. Sands NB, Payne RJ, Côté V, Hier MP, Black MJ, Tamilia M. Female gender as a risk factor for transient post-thyroidectomy hypocalcemia. Otolaryngol Head Neck Surg. 2011 Oct;145(4):561-4. doi: 10.1177/0194599811414511. Epub 2011 Jul 12. PMID: 21750342.[38]
40. Ozogul B, Akcay MN, Akcay G, Bulut OH. Factors affecting hypocalcaemia following total thyroidectomy: a prospective study. Eurasian J Med. 2014 Feb;46(1):15-21. doi: 10.5152/eajm.2014.03. PMID: 25610288; PMCID: PMC4261442.[39]
41. Hosseini M, Otaghvar HA, Tizmaghz A, Shabestanipour G, Vahid PA. Evaluating the Time Interval for Presenting the Signs of Hypocalcaemia after Thyroidectomy. J Clin Diagn Res. 2016 Mar;10(3):PC19-22. doi: 10.7860/JCDR/2016/15274.7445. Epub 2016 Mar 1. PMID: 27134928; PMCID: PMC4843313.[40]
42. Mitra I, Nichani JR, Yap B, Homer JJ. Effect of central compartment neck dissection on hypocalcaemia incidence after total thyroidectomy for carcinoma. J Laryngol Otol. 2011 May;125(5):497-501. doi: 10.1017/S0022215110002471. Epub 2010 Nov 25. PMID: 21106140.[41]
43. Shuchleib-Cung A, Garcia-Gordillo JA, Ferreira-Hermosillo A, Mercado M. Risk factors for hypocalcemia after total thyroidectomy. Cir Cir. 2022;90(6):765- 769. English. doi: 10.24875/CIRU.21000579. PMID: 36472864.[42]
44. Arumugam S, Mohankumar A, Muthukumaraswamy A, Anandan H (2017) Clinical study of Hypocalcemia following Thyroid Surgery. International Journal of Scientific Study,4(11):37-41 [43]
45. Erbil Y, Barbaros U, Temel B, Turkoglu U, Issever H, Bozbora A, et al (2009).The impact of age, vitamin D3 level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy. Am J Surg, 197:439-46 [44]
46. Ramakrishna Bezawada, Narendra MC, Mutheeswaraiah Y, Rukmangadha N. (2023).The Incidence of Hypocalcemia following Total Thyroidectomy: A Retrospective Study. SVU- International Journal of Medical Sciences. Vol.6, Issue 1, pp:457-464 [45]
47. Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. (2014). Systematic review and metanalysis of predictors of post thyroidectomy hypocalcemia, Br J Surg.101(4):307-20 [46]
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2. Alqahtani SM, Alatawi AS, Alalawi YS. Post-Thyroidectomy Hypocalcemia: A Single-Center Experience. Cureus. 2021 Nov 29;13(11):e20006. doi: 10.7759/cureus.20006. PMID: 34987897; PMCID: PMC8716130.[2]
3. Del Rio P, Rossini M, Montana CM, Viani L, Pedrazzi G, Loderer T, Cozzani F. Postoperative hypocalcemia: analysis of factors influencing early hypocalcemia development following thyroid surgery. BMC Surg. 2019 Apr 24;18(Suppl 1):25. doi: 10.1186/s12893-019-0483-y. PMID: 31074401; PMCID: PMC7402573.[3]
4. Kim YS. Impact of preserving the parathyroid glands on hypocalcemia after total thyroidectomy with neck dissection. J Korean Surg Soc. 2012 Aug;83(2):75-82. doi: 10.4174/jkss.2012.83.2.75. Epub 2012 Jul 25. PMID: 22880180; PMCID: PMC3412187.[4]
5. GRAY‘S Anatomy 42 edition page 285 [5]
6. Allen E, Fingeret A. Anatomy, Head and Neck, Thyroid. 2023 Jul 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 29262169. [6]
7. Bhargav PR. Salient anatomical landmarks of thyroid and their practical significance in thyroid surgery: a pictorial review of thyroid surgical anatomy (revisited). Indian J Surg. 2014 Jun;76(3):207-11. doi: 10.1007/s12262-013-0856-x. Epub 2013 Jan 27. PMID: 25177118; PMCID: PMC4141060. [7]
8. Yalçin B, Poyrazoglu Y, Ozan H. Relationship between Zuckerkandl's tubercle and the inferior laryngeal nerve including the laryngeal branches. Surg Today.2007;37(2):109-13. doi: 10.1007/s00595-006-3346-y. Epub 2007 Jan 25. PMID: 17243027. [8]
9. Ilahi A, Muco E, Ilahi TB. Anatomy, Head and Neck, Parathyroid. 2023 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 30725888. [9]
10. Ganong physiology 26th edition page 369-382[10]
11. Guyton and Hall Textbook of medical physiology 14th edition page 991-1004 [11]
12. HARRISON‘S principles of internal medicine 21st edition page 3160, 3185 [12]
13. Sinha V, Chaudhari NP, Jha SG, Parmar BD, Patel RS, Dave GP. Post- Thyroidectomy Hypocalcemia: Clinical Study at Tertiary Care Center. Indian J Otolaryngol Head Neck Surg. 2022 Oct;74(Suppl 2):2076-2081. doi: 10.1007/s12070-020-02023-4. Epub 2020 Aug 3. PMID: 36452542; PMCID: PMC9702187.[13]
14. Orloff LA, Wiseman SM, Bernet VJ, Fahey TJ 3rd, Shaha AR, Shindo ML, Snyder SK, Stack BC Jr, Sunwoo JB, Wang MB. American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults. Thyroid. 2018 Jul;28(7):830-841. doi: 10.1089/thy.2017.0309. Epub 2018 Jun 29. PMID: 29848235. [14]
15. SABISTON TEXTBOOK of SURGERY 21st edition Page 910-916 [15]
16. Bailey and love‘s SHORT PRACTICE OF SURGERY 28th edition Page 863- 866 [16]
17. Bliss RD, Gauger PG, Delbridge LW. Surgeon's approach to the thyroid gland: surgical anatomy and the importance of technique. World J Surg. 2000 Aug;24(8):891-7. doi: 10.1007/s002680010173. PMID: 10865032. [17]
18. Liang JJ, Irizarry R, Victor LS, Hoepner LA, Chernichenko N. Postoperative Complications After Total Thyroidectomy for Patients With Graves' Disease. Otolaryngol Head Neck Surg. 2023 Apr;168(4):754-760. doi: 10.1177/01945998221108050. Epub 2023 Jan 27. PMID: 35763358. [18]
19. Ancuta Leahu, Vanessa carroni, G.Bilotti, calcium level, a pedictive factor of hypocalcemia following total thyroidectomy, Jurnalul Chirurgie ,lasi, 2009, Vol5.Nr.2 (ISSN 1584-9341)[19]
20. Nahas ZS, Farrag TY, Lin FR, Belin RM, Tufano RP. A safe and cost-effective short hospital stay protocol to identify patients at low risk for the development of significant hypocalcemia after total thyroidectomy. Laryngoscope. 2006 Jun;116(6):906-10. doi: 10.1097/01.mlg.0000217536. 83395.37. PMID: 16735895. [20]
21. Graff AT, Miller FR, Roehm CE, Prihoda TJ. Predicting hypocalcemia after total thyroidectomy: parathyroid hormone level vs. serial calcium levels. Ear Nose Throat J. 2010 Sep;89(9):462-5. PMID: 20859873.[21]
22. Sonkhya N, Agarwal S, Choudhary MP, Gupta N. Serial Estimation of Serum Calcium and Ionic Calcium Level for Early Detection of Hypocalcemia After Total/Completion Thyroidectomy. Indian J Otolaryngol Head Neck Surg. 2023 Dec;75(4):3493-3496. doi: 10.1007/s12070-023-04031-6. Epub 2023 Jul 1. PMID: 37974829; PMCID: PMC10645760. [22]
23. Al Maawali H, Al Badaai Y. Serum calcium relative decline as a predictor of post thyroidectomy hypocalcaemia. J Laryngol Otol. 2025 Feb;139(2):125-128. doi: 10.1017/S0022215124001270. Epub 2024 Oct 22. PMID: 39435505. [23]
24. Walsh SR, Kumar B, Coveney EC. Serum calcium slope predicts hypocalcaemia following thyroid surgery. Int J Surg. 2007 Feb;5(1):41-4. doi: 10.1016/j.ijsu.2006.03.006. Epub 2006 May 23. PMID: 17386914. [24]
25. Lee YH, Liu Z, Zheng L, Qiu J, Sang J, Guan W. The Rate of Postoperative Decline in Parathyroid Hormone Levels Can Predict Symptomatic Hypocalcemia Following Thyroid Cancer Surgery with Neck Lymph Node Dissection. Nutr Cancer. 2025;77(1):1-8. doi: 10.1080/01635581.2024.2401179. Epub 2024 Sep 23. PMID: 39313935. [25]
26. Lam A, Kerr PD. Parathyroid hormone: an early predictor of postthyroidectomy hypocalcemia. Laryngoscope. 2003 Dec;113(12):2196-200. doi: 10.1097/00005537-200312000-00029. PMID: 14660927. [26]
27. AlQahtani A, Parsyan A, Payne R, Tabah R. Parathyroid hormone levels 1 hour after thyroidectomy: an early predictor of postoperative hypocalcemia. Can J Surg. 2014 Aug;57(4):237-40. doi: 10.1503/cjs.008013. PMID: 25078927; PMCID: PMC4119114. [27]
28. Soon PS, Magarey CJ, Campbell P, Jalaludin B. Serum intact parathyroid hormone as a predictor of hypocalcaemia after total thyroidectomy. ANZ J Surg. 2005 Nov;75(11):977-80. doi: 10.1111/j.1445-2197.2005.03593.x. PMID: 16336392. [28]
29. Semanate F, Tarupi W, Fernandez Trokhimtchouk T, Palacios C, Jaramillo O. The Role of Parathyroid Hormone Level as a Predictor of Hypocalcemia After Total Thyroidectomy for Thyroid Cancer: A Cross-Sectional Study. Cureus. 2025 Feb 12;17(2):e78897. doi: 10.7759/cureus.78897. PMID: 40091995; PMCID: PMC11908629.[29]
30. Maheshwari M, Khan IA. Risk Factors for Transient and Permanent Hypoparathyroidism Following Thyroidectomy: A Comprehensive Review. Cureus. 2024 Aug 9;16(8):e66551. doi: 10.7759/cureus.66551. PMID: 39258042; PMCID: PMC11383864.[30]
31. Trupka A, Sienel W. Simultane Autotransplantation von Nebenschilddrüsengewebe im Rahmen der totalen Thyreoidektomie
32. parathyroid gland during thyroidectomy in benign thyroid disease minimizes the risk of permanent hypoparathyroidism]. Zentralbl Chir. 2002 May;127(5):439-42. German. doi: 10.1055/s-2002-31974. PMID: 12058305.
33. Barczyński M, Gołkowski F, Nawrot I. Parathyroid transplantation in thyroid surgery. Gland Surg. 2017 Oct;6(5):530-536. doi: 10.21037/gs.2017.06.07. PMID: 29142845; PMCID: PMC5676165.[32]
34. Lahey FH. The transplantation of parathyroids in partial thyroidectomy. Surg Gynecol Obstet. 1926;62:508–9. [33]
35. Zedenius J, Wadstrom C, Delbridge L. Routine autotransplantation of at least one parathyroid gland during total thyroidectomy may reduce permanent hypoparathyroidism to zero. Aust N Z J Surg. 1999 Nov;69(11):794-7. doi: 10.1046/j.1440-1622.1999.01697.x. PMID: 10553968. [34]
36. Lo CY. Parathyroid autotransplantation during thyroidectomy. ANZ J Surg. 2002 Dec;72(12):902-7. doi: 10.1046/j.1445-2197.2002.02580.x. PMID: 12485231. [35]
37. Olson JA Jr, DeBenedetti MK, Baumann DS, Wells SA Jr. Parathyroid autotransplantation during thyroidectomy. Results of long-term follow-up. Ann Surg. 1996 May;223(5):472-8; discussion 478-80. doi: 10.1097/00000658- 199605000-00003. PMID: 8651738; PMCID: PMC1235165. [36]
38. Calcium as a predictor of hypocalcemic symptoms post total thyroidectomy. Osteoporos Int. 2019 Dec;30(12):2495-2504. doi: 10.1007/s00198-019-05040-4. Epub 2019 Aug 28. PMID: 31463588.[37]
39. Sands NB, Payne RJ, Côté V, Hier MP, Black MJ, Tamilia M. Female gender as a risk factor for transient post-thyroidectomy hypocalcemia. Otolaryngol Head Neck Surg. 2011 Oct;145(4):561-4. doi: 10.1177/0194599811414511. Epub 2011 Jul 12. PMID: 21750342.[38]
40. Ozogul B, Akcay MN, Akcay G, Bulut OH. Factors affecting hypocalcaemia following total thyroidectomy: a prospective study. Eurasian J Med. 2014 Feb;46(1):15-21. doi: 10.5152/eajm.2014.03. PMID: 25610288; PMCID: PMC4261442.[39]
41. Hosseini M, Otaghvar HA, Tizmaghz A, Shabestanipour G, Vahid PA. Evaluating the Time Interval for Presenting the Signs of Hypocalcaemia after Thyroidectomy. J Clin Diagn Res. 2016 Mar;10(3):PC19-22. doi: 10.7860/JCDR/2016/15274.7445. Epub 2016 Mar 1. PMID: 27134928; PMCID: PMC4843313.[40]
42. Mitra I, Nichani JR, Yap B, Homer JJ. Effect of central compartment neck dissection on hypocalcaemia incidence after total thyroidectomy for carcinoma. J Laryngol Otol. 2011 May;125(5):497-501. doi: 10.1017/S0022215110002471. Epub 2010 Nov 25. PMID: 21106140.[41]
43. Shuchleib-Cung A, Garcia-Gordillo JA, Ferreira-Hermosillo A, Mercado M. Risk factors for hypocalcemia after total thyroidectomy. Cir Cir. 2022;90(6):765- 769. English. doi: 10.24875/CIRU.21000579. PMID: 36472864.[42]
44. Arumugam S, Mohankumar A, Muthukumaraswamy A, Anandan H (2017) Clinical study of Hypocalcemia following Thyroid Surgery. International Journal of Scientific Study,4(11):37-41 [43]
45. Erbil Y, Barbaros U, Temel B, Turkoglu U, Issever H, Bozbora A, et al (2009).The impact of age, vitamin D3 level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy. Am J Surg, 197:439-46 [44]
46. Ramakrishna Bezawada, Narendra MC, Mutheeswaraiah Y, Rukmangadha N. (2023).The Incidence of Hypocalcemia following Total Thyroidectomy: A Retrospective Study. SVU- International Journal of Medical Sciences. Vol.6, Issue 1, pp:457-464 [45]
47. Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. (2014). Systematic review and metanalysis of predictors of post thyroidectomy hypocalcemia, Br J Surg.101(4):307-20 [46]
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Published
Jul 31, 2025
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How to Cite
Dr. Hemand N M, Dr. Amisha Saxena, Dr. Nishitha Prashanth, & Dr. Tripti Pandey. (2025). CLINICAL EVALUATION OF HYPOCALCEMIA AFTER THYROIDECTOMY. Journal of Population Therapeutics and Clinical Pharmacology, 32(6), 1572-1614. https://doi.org/10.53555/cameav89
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Author Biographies
Dr. Hemand N M
MBBS MS, General Surgery, Rajarajeswari Medical College, Bangalore, India
Dr. Amisha Saxena
MBBS MS, General Surgery, Rajarajeswari Medical College, Bangalore, India
Dr. Nishitha Prashanth
MBBS MS, General Surgery, Rajarajeswari Medical College, Bangalore, India
Dr. Tripti Pandey
MBBS MS, General Surgery, Rajarajeswari Medical College, Bangalore, India
How to Cite
Dr. Hemand N M, Dr. Amisha Saxena, Dr. Nishitha Prashanth, & Dr. Tripti Pandey. (2025). CLINICAL EVALUATION OF HYPOCALCEMIA AFTER THYROIDECTOMY. Journal of Population Therapeutics and Clinical Pharmacology, 32(6), 1572-1614. https://doi.org/10.53555/cameav89