Endocrine Abstracts

Introduction: Hypocalcaemia secondary to post-operative hypoparathyroidism is a recognised complication of thyroid surgery with reported rates of up to 75%. Little guidance exists on the appropriate management of post-operative hypocalcaemia and individual clinicians may develop their own preferred management strategies based on past experience. However, delay in restoring normocalcaemia may increase length of hospital stay and patient morbidity.

Aims: i) To identify the local incidence of hypocalcaemia following completion and total thyroidectomy; ii) to determine the post-operative management of hypocalcaemia and its impact on length of stay at our centre; iii) to develop a ward guideline for hypocalcaemia management.

Methods: A retrospective review of patients undergoing total or completion thyroid surgery between 1st April 2007 and 31st March 2009.

Results: Twenty-nine patients were included. Thirteen patients (44.8%) developed a serum calcium of ≤2.0 mmol/l during the first three post-operative days. Patients undergoing total thyroidectomy were significantly more likely to develop hypocalcaemia (P<0.05). The mean length of stay (LOS) was 4.2 days. The development of hypocalcaemia was significantly associated with a prolonged LOS (P=0.007). Hypocalcaemia was the primary reason for delayed discharge in 11 patients (37.9%). Mean LOS for patients who developed hypocalcaemia was 7.0 days, compared with 2.0 days for those who did not. This resulted in an additional 55 days of hospital stay during the study period The management of hypocalcaemia was found to be variable both for oral and intravenous therapy. At 6 months only 1 patient (5.6%) was requiring calcium supplementation.

Conclusions: Our rates of hypocalcaemia are in line with the published literature with a low incidence of permanent hypocalcaemia. Hypocalcaemia increases LOS and its management in our institution appears variable. We present a management algorithm for post-operative hypocalcaemia with the aims of maintaining uniformity of management, reducing LOS and reducing patient morbidity.