Endocrine Abstracts

Background: The national audit from the British Association of Endocrine Surgeons and the Scandinavian Quality Register of Thyroid and Parathyroid Surgery have reported that 7–17% of patients have hypocalcaemia in the first 6 weeks after thyroid surgery. This study is a snap-shot of management of peri-operative hypocalcaemia using routine Calcichew supplements.

Methods: Retrospective review clinical and biochemical data on consecutive patients undergoing total thyroidectomy. Harmonic scalpel was used in all operations. Patients were prescribed Calcichew 1 g qds for 2 weeks postoperatively and were discharged on day 1–3 postop with information on how to recognise symptomatic hypocalcaemia and how to decide to reduce gradually the daily dose of Calcichew. A minority of patients (n=12) were discharged same day without immediate biochemical assessment.

Results: Between February 2007 and May 2008, 80 patients (58F:22M, age 15–84 years) underwent total thyroidectomy for Graves disease (n=26), benign pathology (n=30) or thyroid cancer (n=24). In 13 patients (16%) 15 parathyroid glands were removed incidentally.

Biochemical hypocalcaemia (Ca <2.1 mmol/l) was observed in 14 of 68 patients (21%) in the first day postop. The gland weight was higher in these patients was higher than in normocalcaemic patients (129±91 vs 102±110 g, P=NS). Parathyroid hormone levels were measured in 28 patients on day 1 postop: four of six patients with <0.3 pmol/l developed permanent hypocalcaemia.

Long-term hypocalcaemia was observed in 6 of 80 patients (7.5%) at over 6 months follow-up. Three of these patients underwent total thyroidectomy+radical modified neck dissection for locally advanced thyroid cancer and two had very large goiters (>300 g).

Only one patient in this cohort was readmitted with symptomatic severe hypocalcaemia (1.6 mmol/l).

Conclusion: Routine administration of oral calcium supplements allow early discharge from hospital after total thyroidectomy with very low rate of readmission for symptomatic hypocalcaemia.