Endocrine Abstracts

Objectives: We aim to correlate the risk of hypocalcemia with mediastinal-recurrent cellular and lymph-node dissection, whether unilateral or bilateral, and incidental parathyroidectomy after total thyroidectomy.

Material and Methods: A retrospective study was conducted over a four-year period from 2020 to 2023 in the Department of Otorhinolaryngology and Cervicofacial Surgery at Salah Azaiz Institute in Tunisia. The study included 85 patients who underwent total thyroidectomy with mediastinal-recurrent cellular and lymph node dissection. The correlation between bilateral and unilateral mediastinal-recurrent cellular and lymph-node dissection and incidental parathyroidectomy and the risk of hypocacalcemia was investigated in the immediate postoperative period, as well as at 1 month and 6 months following surgery. Hypocalcemia was defined as a total serum calcium concentration < 2.20 mmol/l. Persistent hypocalcemia was defined as hypocalcemia persisting for 6 months.

Results: 85 patients were included, with a sex ratio of 0.2 (17 men, 68 women). The age range was between 9 and 85 years, with a median of 45.6. In the immediate postoperative period, 28 patients (32.9%) showed hypocalcemia, and 12 of those required intravenous supplementation due to severe hypocalcemia. Bilateral mediastinal-recurrent cellular and lymph-node dissection was not associated with a statistically significant increase in the risk of immediate hypocalcemia compared to unilateral mediastinal-recurrent cellular and lymph-node dissection (P = 0.41), but the risk was significant at 1 month (P = 0.02) and at 6 months. Incidental parathyroidectomy did not significantly increase the rate of early hypocalcemia (P = 0.28), but it was associated with a worsening at 1 month (P = 0.01) and a higher risk of persistent hypocalcemia.

Conclusion: Hypocalcemia represents one of the most challenging complications following thyroid surgery. Bilateral mediastinal-recurrent cellular and lymph-node dissection may be linked to an increased risk of persistent hypocalcemia, primarily due to the heightened risk of devascularization related to per operative manipulation and incidental parathyroidectomy.