If two consecutive calcium values within the normal range are stable or increasing, discontinue checking and patient is tapered off calcium supplementation. Of note 2. If calcium is decreasing, increase oral calcium to 4 gm elemental per day. If this stabilizes the calcium, arrangements for the above taper regimen beginning at 1 gm QID and tapering down by one gm per week are made at discharge. Check and correct abnormal magnesium. The patient should have calcium checked 1 week after discharge locally or at UIHC follow-up.
If calcium continues to decrease to below 3. If continued decrease in calcium or symptoms, increase to 0. The information obtained from this study was used to create a risk stratification scheme for developing and managing postoperative hypocalcemia that we have implemented in our practice Figure 2. We incorporated the predictors of hypocalcemia identified in this study into our previous management protocol to create a personalized algorithm for the safe management and discharge of patients after total thyroidectomy.
The major limitations of this study include its retrospective nature, as well as the fact that the postoperative calcium levels recorded were not corrected for serum albumin levels, which may have falsely increased the number of patients in the mild hypocalcemia category.
Sex, postoperative IPTH levels, and the indication for the thyroidectomy are factors that can be used to risk stratify patients for the development of hypocalcemia after total thyroidectomy. A low postoperative IPTH level, female sex, and thyroid malignant neoplasm are all independent predictors of postoperative hypocalcemia. These variables should all be taken into account when decisions are being made about how to most effectively prevent or manage postoperative hypocalcemia after total thyroidectomy.
Submitted for Publication: May 8, ; final revision received August 2, ; accepted August 25, Corresponding Author: Ralph P. Published Online: October 16, Author Contributions: Drs Noureldine and Tufano had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Noureldine and Genther served as co—first authors, each with equal contribution to the manuscript. Acquisition, analysis, or interpretation of data: Noureldine, Genther, Agrawal, Tufano.
Critical revision of the manuscript for important intellectual content: All authors. Conflict of Interest Disclosures: None reported. Role of the Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue.
Figure 1. View Large Download. Figure 2. Table 1. Demographic and Clinical Characteristics of the Study Population. Table 2. Table 3. Laparoscopic cholecystectomy as an outpatient procedure. J Am Coll Surg. PubMed Google Scholar Crossref. Outpatient laparoscopic gastric banding: initial experience. Obes Surg. Thiel J, Gamelin A. Outpatient total laparoscopic hysterectomy. J Am Assoc Gynecol Laparosc. Epidemiological and economic trends in inpatient and outpatient thyroidectomy in the United States, American Thyroid Association statement on outpatient thyroidectomy.
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Concentrations of other electrolytes, osmolarity, proteins, and albumin followed the same pattern of evolution. After thyroidectomy, the degree and duration of hypocalcemia increased with the extent of thyroid resection. Calcitonin values did not increase after thyroidectomy.
A slight correlation was observed between the preoperative serum alkaline phosphatase level and the minimal postoperative serum calcium level. It is concluded that postthyroidectomy hypocalcemia is a multifactorial phenomenon. It is due, at least in part, to hemodilution. A temporary parathyroid insufficiency after subtotal and total thyroidectomy, and an avidity of the skeleton for calcium in hyperthyroid patients, may aggravate the hypocalcemia.
Hypocalcemia After Thyroidectomy. Arch Surg. Coronavirus Resource Center. Our website uses cookies to enhance your experience.
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