Endocrine Abstracts

Background: Although hypocalcemia is common post thyroidectomy, no national guidelines pertain to its management.

Long-term treatment with calcium and vitamin D replacement predispose patients to nephrocalcinosis and should be avoided in the absence of a clear indication.

Aim: To identify the incidence and management of post-operative hypocalcemia following thyroidectomy in a UK teaching hospital with view to formulating management guidelines.

Method: Patients who underwent thyroid surgery between 2007 and 2008 were identified by theatre lists. Case notes were reviewed to determine demographic details, incidence of hypocalcemia and the treatment given. Out patient review appointments were examined to identify if a trial off supplements had been offered.

Results: One hundred and twenty-seven patients underwent thyroid surgery between 2007 and 2008. Ninety-one patients were included in the audit and 36 excluded due to missing data.

Of 33/91 (36.3%) patients were treated with calcium supplements post operatively. Of 25/91 (27.5%) had documented hypocalcemia. Mean pre-operative serum calcium (S.D.) was 2.36 mmol/l (0.13). Nadir serum calcium on the first, second and third post-operative day was 2.00, 1.82 and 1.89 mmol/l respectively. No significant differences in serum calcium between men and women post operatively (P value=NS).

Mean hospital stay (S.D.) following surgery was 3.9 (1.3) days 16 patients were treated with Sandocal, 4 with 1-α-calcidol and 13 with both. Three patients required intravenous calcium.

Twenty-nine patients were discharged with calcium and /or α-calcidol. At data analysis 8/29 (27.6%) patients remained on supplements. Replacement therapy was discontinued in seven patients at their post-operative clinic review and in 11 patients at the discretion of their general practitioner.

Conclusion: There is wide variation in management of hypocalcaemia post thyroid surgery.

Large proportion of patients remain on long-term replacement without a clear indication and a trial off treatment is needed to ascertain the need for long-term therapy.