Hypocalcemia Followed by Total Thyroidectomy with Central Neck Dissection

Koh, Joong Wha; Ahn, Sung Yoon; Kim, Hui Zun; Shin, Jee Churl

Abstract

BACKGROUND AND OBJECTIVES
There are many controversies about the extent of thyroidectomy and neck dissection in cases of thyroid cancer. Hypocalcemia is one of serious complications after total thyroidectomy. The on-set of hypocalcemia depends on many factors and different literature cites variable incidence. This study was performed to evaluate the incidence of postoperative hypocalcemia and the safety of total thyroidectomy with central neck dissection in thyroid cancer.
MATERIALS AND METHODS
We conducted a retrospective chart review of 17 patients who underwent total thyroidectomy for thyroid malignancies from June 1995 to December 1998. Routine central neck dissection was performed and modified radical neck dissection was done in cases with positive neck node. We analyzed the onset-time of hypocalcemia, serum albumin level, hypocalcemic incidence according to the number of identified and autotransplanted parathyroid glands, lowest calcium level, clinical features and duration of calcium replacement in hypocalcemic patients.
RESULTS
The incidence of postoperative hypocalcemia was 76.5% (13/17)and most cases (58.9%)occurred on the first postoperative day. The serum albumin level was lower on the first postoperative day than on the third postoperative day. The average number of identified parathyroid glands was three, and the more parathyroid glands there are, the less hypocalcemia we found. Parathyroid gland autotransplantation were performed in 12 cases. Symptomatic transient hypocalcemia occurred in 6 cases (35.2%). Asymptomatic transient hypocalcemia occurred in 6 cases (35.2%). Permanent hypocalcemia occurred in 1 case (5.9%).
CONCLUSION
The incidence of postoperative hypocalcemia was relatively high but half of them were asymptomatic. There are no need for thyroid hormone replacement in asymptomatic transient hypocalcemic patients and that we found total thyroidectomy with central neck dissection is a safe procedure in most of thyroid malignancies.