THE ROLE OF EARLY POSTOPERATIVE PARATHYROID HORMONE IN PREDICTING LONG-TERM HYPOCALCEMIA FOLLOWING TOTAL THYROIDECTOMY: A LONGITUDINAL STUDY
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Keywords
Total thyroidectomy, parathyroid hormone, hypocalcemia, hypoparathyroidism
Abstract
Background: Thyroid diseases are among the most common endocrine disorders worldwide, and India is no exception. Total thyroidectomy has become the primary surgical treatment for many thyroid conditions, including both benign and malignant diseases. This study was therefore designed to prospectively evaluate the incidence of long-term hypocalcemia in patients undergoing total or completion thyroidectomy and to determine the predictive value of PTH and serum calcium levels measured within the first 24 hours post-surgery.
Aim: Role of immediate post operative serum parathyroid hormone (PTH) level to predict long term hypocalcemia in patient undergoing total thyroidectomy
Material and method: A longitudinal study conducted the Dept of E.N.T. RIMS, Imphal. Among 61 patients underwent total thyroidectomy and completion thyroidectomy included in this study for two years, from September 2022 to June 2024. Serum PTH and calcium levels were measured within 24 hours of the surgery. All patients were followed up at 3 months and 6 months postoperatively, with serum calcium levels measured at each visit to assess for recovery or persistence of hypocalcemia.
Results:
Our showed pronounced female predominance (96.7%) and a mean age of 44.6 years, with the majority falling within the 41–60-year age group. Preoperative FNAC results were predominantly malignant, with papillary thyroid carcinoma comprising 85.2% of cases. Baseline PTH, serum calcium, and Vitamin D—were within normal reference range. In the immediate postoperative period: hypocalcemia was observed in 96.7% of patients, and 77% developed hypoparathyroidism. At 3 months, 40.9% remained hypocalcemic; however, by 6 months, only 6.55% had persistent hypocalcemia, reflecting substantial restoration of calcium homeostasis.
Conclusion: Overall, thyroidectomy often results in temporary biochemical changes but rarely causes long-term problems. Early postoperative PTH testing is useful for identifying patients at risk and starting treatment promptly, but results should be interpreted cautiously. Ongoing monitoring is important because recovery varies from patient to patient.
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Saurabh Shukla
Senior Resident, Department of Otorhinolaryngology, Regional Institute of Medical Sciences, Manipur, India
Oinam Priyokumar Singh
Associate Professor, Department of Otorhinolaryngology, Regional Institute of Medical Sciences, Manipur, India
Ningombam Jiten Singh
Assistant Professor, Department of Otorhinolaryngology, Jawaharlal Nehru Institue of Medical Sciences, Manipur, India
Vanathu Mariyapragasam. M
Senior Resident, Department of Otorhinolaryngology, Regional Institute of Medical Sciences, Manipur, India
Ladeiti Hynniewta
Senior Resident, Department of Otorhinolaryngology, Regional Institute of Medical Sciences, Manipur, India
Thongam Kalpana Devi
Assistant Professor, Department of Otorhinolaryngology, Regional Institute of Medical Sciences, Manipur, India
Th Sudhiranjan Singh
Professor, Department of Otorhinolaryngology, Regional Institute of Medical Sciences, Manipur, India
