Endocrine Abstracts

Background: Total and completion thyroidectomy are commonly performed operations for the treatment of thyroid disease. Post-operative hypocalcaemia is a frequent complication of this surgery, and is associated with morbidity and prolonged length of stay (LOS).

Methods: In January 2010 we introduced a protocol for the avoidance and management of post-operative of hypocalcaemia based on risk-stratification by post-operative PTH levels in patients undergoing thyroidectomy. We audited hypocalcaemia rates for the year prior to, and the year following introduction of the protocol. The incidence of temporary hypocalcaemia (hypocalcaemia lasting less than 6 months) and permanent hypocalcaemia (hypocalcaemia lasting more than 6 months) and LOS were recorded.

Results: 71 patients (51 female, 20 male) underwent thyroidectomy (53 total, 18 completion) between the 1st January 2009 and 31st December 2010. Following introduction of the protocol, rates of temporary hypocalcaemia fell from 22.6% to 17.5% and rates of all hypocalcaemia fell from 35.5% to 25%. The overall rate of post-operative hypocalcaemia for total thyroidectomy in 2010 was 21.2%, which is below the national average of 29.6% (British Association of Endocrine and Thyroid Surgeons, Third National Audit 2009). Mean LOS was reduced in patients with post-operative hypocalcaemia from 115.5 (standard deviation [SD] = 80.5) hours to 85.2 (SD = 33.6) hours, representing a greater than 25% reduction.

Conclusions: Introduction of the protocol was associated with reduction in rates of hypocalcaemia and LOS. We think that the reduced rate of temporary hypocalcaemia is attributable to the early initiation of alpha calcidol therapy in patients with high risk post-operative PTH levels and that the reduced rates of permanent hypocalcaemia may reflect more vigorous attempts to wean patients off alpha calcidol now that all post-operative hypocalcaemia follow up is focused in one consultant’s clinic. The reduced LOS will have a significant health-economic benefit.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.