Endocrine Abstracts

Hypocalcaemia following thyroidectomy may be temporary or permanent, usually occurring within 14–72 h. The British Association of Endocrine Surgeons 2009 audit reported long-term hypocalcaemia rates of 7%. Total thyroidectomy for Graves’s disease carries the greatest risk (reported in 6–30% of cases) and currently there is no national consensus on management of this complication.

We present three healthy young women who underwent total thyroidectomy for Graves disease. Medical management failed following poor compliance and attendance to endocrinology. Radioactive iodine was declined or deemed impractical.

Postoperatively all women were hypocalcaemic and required oral calcium. In addition they received i.v. high dose calcium plus alfacalcidol as they become symptomatic with falling serum levels (lowest immediate cCa 1.7 mmol). Calcium replacement was not given preoperatively. The longest immediate inpatient stay was 14 days however all women required subsequent prolonged admissions after presenting acutely with symptoms in the 1st 8 weeks (lowest cCa 1.6 mmol).

They had daily endocrine review and one lady commenced recombinant PTH for 8 months.

PTH measured at 4 weeks was undetectable and in one case remains undetectable at 12 weeks. Histology did not identify parathyroid tissue and there was no documentation of damaged parathyroid tissue in theatre notes.

This series highlights the significant morbidity associated with hypocalcaemia. In our patients, compliance was already an issue and they all continue on multiple daily tablets. We continue to see them regularly with close serum monitoring to prevent repeated admission.

This has highlighted in our own centre the need for a local management protocol. At present intraoperative PTH measurement is not available however data is varied to support its use as a positive predictor. There is a move for some centres to perform total thyroidectomy for benign disease as day case and we would advise caution following our clinical experience.