Serum Phosphate may predict Temporary Hypocalcaemia after Total Thyroidectomy
Hypocalcaemia is the commonest complication following total thyroidectomy and is mainly due to parathyroid insufficiency. A study published in the Indian Journal of Surgery suggests serum phosphate can be a reliable predictor of post-thyroidectomy hypocalcaemia which aids in early management thus avoiding complications and reducing treatment cost.
Despite the expertise of surgeons, postsurgical hypocalcemia remains a prevalent complication in patients undergoing total thyroidectomy and/or central lymph node dissection, causing high post-operative morbidity and compromising the quality of life and increasing costs to the health system. Some efforts have been made to find, intra and post-operative hypocalcemia predictors in an attempt to prevent and reduce the number of post-operative admissions to the emergency room, and improve morbidity. For the same purpose, Dr Sukumaran conducted a study to evaluate the effect of serum phosphate levels in predicting temporary hypocalcaemia.
It was a prospective cross-sectional study of 118 patients (104 female; 14 male) who underwent total thyroidectomy, at Amrita Institute of Medical Sciences, Kochi, from June 2014 to June 2016. The researcher assessed the Patients serum calcium and phosphate levels pre-operatively, on the evening of surgery (day 0), on the morning of day 1 and over the following week until discharge.
Key findings of the study were:
♦Among 118 patients, thirty-seven developed biochemical hypocalcaemia (< 7.8 mg/dL) out of whom, 31 were symptomatic.
♦The researcher noted thirty-six patients (30.5%) developed treatment requiring symptomatic hypocalcaemia, out of whom, 5 did not have a drop in serum calcium levels.
♦He observed 46 patients had a rise in serum phosphate level and 42 patients had temporary hypocalcaemia among which 29 had a day 1 hyperphosphataemia and 33 had early hyperphosphataemia.
♦He also observed a total of 44 patients with early hyperphosphataemia. He reported that most of the patients who developed hypocalcaemia (15 patients) did so on the second post-operative day.
♦After analysis, he found the change in mean values of serum phosphate from baseline pre-operative value to day 0 and to day 1 was significant in those patients who developed hypocalcaemia on day 2.
The author concluded, "Serum phosphate can be used as a reliable predictor of post-thyroidectomy hypocalcaemia which would help in the safe early discharge of patients".
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