Dexamethasone use may prevent hypocalcemia and voice dysfunction post-thyroidectomy: JAMA

Pakistan: A recent study in the journal JAMA Otolaryngology-Head Neck Surgery, has found single-dose preoperative dexamethasone to be safe and effective in reducing postoperative voice dysfunction and hypocalcemia after thyroidectomy.

Total thyroidectomy is associated with the risk of vocal quality dysfunction and temporary hypocalcemia. Dexamethasone, a corticosteroid similar to a natural hormone produced by adrenal glands, is proposed to have a physiological effect on voice quality and hypocalcemia.

Against the above background Adeel Abbas Dhahri, Royal Infirmary Hospital Edinburgh, Edinburgh, United Kingdom, and colleagues aimed to assess the effect of preoperative dexamethasone used to improve hypocalcemia and post thyroidectomy voice dysfunction.

The study was designed as a double-blinded, parallel-group, placebo-controlled randomized clinical trial and was conducted from January 15, 2014, to December 31, 2019, at the Department of Surgery, Holy Family Hospital in Rawalpindi, Pakistan. All patients with a benign thyroid condition and no preoperative corrected hypocalcemia and voice or vocal quality dysfunction were included. Patients were excluded if they had previous thyroid or neck surgery, known vocal cord dysfunction on laryngoscopy, hearing or voice problems, a history of gastroesophageal reflux, stomach ulcer disease, or contraindications to steroid use.

The results of the study were found to be

• A total of 192 patients (mean [SD] age, 38.9 years; 156 women [81.2%]) were included in the study, with 96 patients randomized to each study group (dexamethasone group, mean age, 39.2 years; 75 women [78.1%]; placebo group, mean [SD] age, 38.5 [12.9] years; 81 women [84.5%]).

• In the first 24 hours after undergoing thyroidectomy, 47 patients (24.4%) developed hypocalcemia and 18 (9.4%) were symptomatic.

• At 3 days post thyroidectomy, 4 of 96 patients (4.2%) in the placebo group had hypocalcemia compared with no patients in the dexamethasone group.

• At 24 hours post hyroidectomy, 8 of 96 patients (8.3%) in the dexamethasone group had voice dysfunction compared with 32 of 96 patients (33.3%) in the placebo group.

• A total of 40 patients (20.8%) reported voice dysfunction. The absolute reduction in the rate of hypocalcemia at 24 hours was 24% and at 3 days was 4.2%. 

• The rate of symptomatic hypocalcemia was 19% lower in the dexamethasone group than in the placebo group. The rate of voice dysfunction was 25% lower in the dexamethasone group than in the placebo group.

Dhahri, and the team concluded that "In this randomized clinical trial, a single preoperative dose of dexamethasone was safe and effective in reducing postoperative hypocalcemia and voice dysfunction rates in patients undergoing thyroidectomy"

Reference:

Dhahri AA, Ahmad R, Rao A, et al. Use of Prophylactic Steroids to Prevent Hypocalcemia and Voice Dysfunction in Patients Undergoing Thyroidectomy: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. Published online September 02, 2021. doi:10.1001/jamaoto.2021.2190