Serum Calcium Slope Predicts Hypocalcaemia following Thyroid Surgery
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Abstract
Background: Hypocalcemia is one of the most common complications following total thyroidectomy resulted from parathyroid gland injury which causes prolonged hospitalization, increases mortality and cost of care. The aim of this study is therefore to measure serum calcium levels as a useful prediction of post operative hypocalcemia with less laboratory effort and cost.
Objective: To measure serum calcium levels as a useful prediction of post operative hypocalcemia with less laboratory effort and cost.
Study design: Retrospective cohort study
Methods: Retrospective review of patient who underwent thyroid surgery in ear nose throat (ENT) department of Surin hospital from January 2012 to January 2017 was conducted. The study group reported early post operative serum calcium level at 24, 48 and 72 hours of post operative time. The patients were divided in two groups of 1) positive slope (increasing) and 2) non-positive slope (nonchanging/decreasing). We measured serum calcium slope within 24 to 48 hours and 48 to 72 hours after the total thyroidectomy to predict patients who were at risk of hypoparathyroidism by using Chi-square and odd ratio.
Results: A Total of 161 patients who underwent thyroid surgery, there were 65 patients (40.4%) developed hypocalcemia after the surgery and 87 (75%) of 116 of patients with a positive serum calcium slope (measured at 24 and 48 hours) did not develop significant hypocalcemia. Incontrast, 36 (80%) of 45 patients with a non-positive slope developed hypocalcemia (OR of days1 to day2 is 12, 95%CI=5.1-27.8 p=0.00, OR of day2 to day3=13, 95%CI=5.7-32.7). There were 82 of 88 patients (93.1%) with positive slope whose serum calcium level 8 mg/dl on the first postoperative day did not develop hypoparathyroidism therefore this predictive factor considered as the accurate predictor for subsequent postoperative hypoparathyroidism.
Conclusion: Patients with a positive serum calcium slope (measured at 24 and 48 hours) after total thyroidectomy and a serum calcium level 8 mg/dL at 24 hours postoperatively are safe to discharge according to the predictive model altogether with patient education for hypocalcemia self-monitoring, total
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References
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