Ali Iqbal M, Sharma Sarthak, Shetty Varun
Department of General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND.
Cureus. 2024 Aug 17;16(8):e67100. doi: 10.7759/cureus.67100. eCollection 2024 Aug.
Total thyroidectomy constitutes one of the bread-and-butter procedures of surgeons all over the world. Like with any surgical procedure, complications form a part and parcel of the postoperative course in the hospital. Hypocalcemia represents one such prevalent complication post-total thyroidectomy. This study aimed to evaluate the impact of total thyroidectomy on calcium and magnesium levels and to assess the role of magnesium in postoperative hypocalcemia.
This study was carried out at a tertiary health center over a two-year period from 2022 to 2024. It involved 100 participants with thyroid conditions (benign/malignant) who required total thyroidectomy. Patients with pre-existing conditions affecting calcium levels (e.g., chronic renal failure, medullary carcinoma thyroid, etc.) were expressly excluded. Preoperative calcium, magnesium, and parathyroid hormone (PTH) levels were recorded. Intraoperative parameters such as time and fluid volume were also measured. Postoperatively, serum calcium and magnesium levels, PTH levels, and complications like hypocalcemia and hypomagnesemia were monitored. The descriptive statistics were computed to delineate the study sample. After completion of data collection, data analysis was achieved using IBM SPSS Statistics for Windows, V. 16.0 (SPSS Inc., Chicago, IL). The chi-squared test of significance was utilized to establish statistical correlations between calcium and magnesium levels post-total thyroidectomy. A p-value of less than 0.05 was considered statistically significant.
The study analyzed 100 total thyroidectomy patients. The mean age of patients in our study was 50.7±8.86 years, with 97 females and three males. The most common pathology indicating total thyroidectomy was diffuse colloid goiter (46%), followed by multinodular goiter (38%). Only a single patient had preoperative biochemical hypocalcemia or hypomagnesemia, but none exhibited symptoms. After total thyroidectomy, 15% (n=15) developed hypocalcemia, and 11% (n=11) developed hypomagnesemia. Postoperative mean PTH levels slightly decreased to 28.8±11.75 pg/dl, indicating similar variability to preoperative levels. Patients who underwent intra-capsular dissection had a mean postoperative ionic calcium level of 4.89±0.54 mg/dl, while those who underwent extra-capsular dissection had a slightly lower mean ionic calcium level of 4.72±0.76 mg/dl.
Hypocalcemia is one of the most prevalent complications associated with total thyroidectomy. The role of magnesium in maintaining calcium homeostasis after thyroidectomy should be further explored to improve the management of hypocalcemia. Additionally, the type of capsular dissection performed during the surgery can impact the occurrence of hypocalcemia, and using intra-capsular dissection whenever possible may help reduce the incidence of hypocalcemia.
全甲状腺切除术是全球外科医生常见的手术操作之一。与任何外科手术一样，并发症是术后住院过程的一部分。低钙血症是全甲状腺切除术后一种常见的并发症。本研究旨在评估全甲状腺切除术对钙和镁水平的影响，并评估镁在术后低钙血症中的作用。
本研究在一家三级医疗中心进行，为期两年（2022年至2024年）。研究对象为100例需要进行全甲状腺切除术的甲状腺疾病（良性/恶性）患者。明确排除既往有影响钙水平疾病（如慢性肾衰竭、甲状腺髓样癌等）的患者。记录术前钙、镁和甲状旁腺激素（PTH）水平。还测量了手术时间和液体量等术中参数。术后监测血清钙和镁水平、PTH水平以及低钙血症和低镁血症等并发症。计算描述性统计量以描述研究样本。数据收集完成后，使用IBM SPSS Statistics for Windows，V. 16.0（SPSS公司，伊利诺伊州芝加哥）进行数据分析。采用卡方显著性检验来确定全甲状腺切除术后钙和镁水平之间的统计相关性。p值小于0.05被认为具有统计学意义。
本研究分析了100例全甲状腺切除术患者。研究中患者的平均年龄为50.7±8.86岁，其中女性97例，男性3例。表明需要进行全甲状腺切除术的最常见病理类型是弥漫性胶样甲状腺肿（46%），其次是多结节性甲状腺肿（38%）。只有1例患者术前存在生化性低钙血症或低镁血症，但均无相关症状。全甲状腺切除术后，15%（n = 15）发生低钙血症，11%（n = 11）发生低镁血症。术后平均PTH水平略有下降至28.8±11.75 pg/dl，表明与术前水平的变异性相似。行囊内解剖的患者术后平均离子钙水平为4.89±0.54 mg/dl，而行囊外解剖的患者术后平均离子钙水平略低，为4.72±0.76 mg/dl。
低钙血症是全甲状腺切除术后最常见的并发症之一。应进一步探讨镁在甲状腺切除术后维持钙稳态中的作用，以改善低钙血症的管理。此外，手术中进行的囊膜解剖类型可影响低钙血症的发生，尽可能采用囊内解剖可能有助于降低低钙血症的发生率。
