Evaluation of an early detection protocol, intensive treatment and control of post-surgical hypoparathyroidism in the first month after total thyroidectomy

• Published in: Endocrinología, diabetes y nutrición. diabetes y nutrición., 2023-03, Vol.70 (3), p.202-211
• Main Authors: García Pascual, Luis, García González, Lluís, Lao Luque, Xavier, Palomino Meneses, Laura, Viscasillas Pallàs, Guillem
• Format: Article
• Language: English
• Subjects: Calcium - therapeutic use; Cross-Sectional Studies; Hipocalcemia; Hipoparatiroidismo posquirúrgico; Humans; Hypercalcemia - complications; Hypocalcemia; Hypocalcemia - diagnosis; Hypocalcemia - drug therapy; Hypocalcemia - epidemiology; Hypoparathyroidism - diagnosis; Hypoparathyroidism - drug therapy; Hypoparathyroidism - epidemiology; Parathyroid Hormone; Postoperative Complications - etiology; Postsurgical hypoparathyroidism; Retrospective Studies; Thyroidectomy; Thyroidectomy - adverse effects; Tiroidectomía
• ISSN: 2530-0180; 2530-0180
• DOI: 10.1016/j.endien.2023.03.012

Hypoparathyroidism is the most common complication of total thyroidectomy and usually requires monitoring of calcaemia, whereby it is one of the factors that most contributes to hospital stay. The objective of the study is to evaluate the clinical usefulness of the application of our protocol for early detection, intensive treatment and control of hypoparathyroidism in the first month after thyroidectomy. Retrospective observational cross-sectional study of 79 patients who underwent total thyroidectomy in whom parathormone (PTH) and calcemia determinations were performed at 6−8 h and 18−24 h post-surgery. When the PTH value was lower than inferior limit of the reference (15 pg/ml), oral treatment was started with 1000 mg of calcium and 0.25 μg of calcitriol every 8 h followed by calcemia controls. Twenty-six cases (32.9%) of normocalcemic hypoparathyroidism were detected in whom treatment prevented their progression to hypocalcaemia, except for 3 cases that had an episode of mild asymptomatic hypocalcaemia. There were no cases of moderate/severe hypocalcaemia and only one case of asymptomatic mild hypercalcaemia. There were no readmissions due to calcium abnormalities. No case with PTH > 15 pg/ml had hypocalcaemia. The protocol allowed a hospital stay of 24 h. The prevalence of permanent hypoparathyroidism was 5.1%. The application of our protocol during the first month after thyroidectomy is very useful because it avoids the appearance of moderate/severe hypocalcaemia and hypercalcaemia, allows a short hospital stay and is associated with a low prevalence of permanent hypoparathyroidism. El hipoparatiroidismo es la complicación más frecuente de la tiroidectomía total y habitualmente requiere la monitorización de la calcemia, por lo que es el principal factor que determina la estancia hospitalaria. El objetivo del estudio es evaluar la utilidad clínica de la aplicación de nuestro protocolo de detección precoz, tratamiento intensivo y control del hipoparatiroidismo durante el primer mes postiroidectomía. Estudio retrospectivo observacional transversal sobre 79 pacientes sometidos a una tiroidectomía total a quienes se les determinó parathormona (PTH) y calcemia a las 6−8 horas de la intervención y a las 18−24 horas. Cuando el valor de PTH fue menor que el límite inferior de referencia (15 pg/ml) se inició tratamiento oral con 1.000 mg de calcio y 0,25 μg de calcitriol cada 8 horas y controles de calcemia. Se detectaron 26 casos (32,9%) de hipoparatiroidismo