Impact of intraoperative calcium injection for prophylaxis against Hypocalcemia after Total Thyroidectomy for Benign Thyroid Disease

ABSTRACT

Background:

Hypocalcemia, the most common complication of total thyroidectomy, is a transient condition in up to 27% of patients and a permanent condition in 1%. The present study was conducted to assess whether intra-operative parenteral administration of 10 ml calcium gluconate (500 mg of calcium) is beneficial in preventing post-operative hypocalcemia after total thyroidectomy for benign thyroid disease.

Patients and Methods:

This study included 100 consecutive normocalcemic patients with benign thyroid disease who were candidates for total thyroidectomy. Patients included 73 females and 27 males. Their ages ranged from 18 to 55 years, with a mean of 35.7±9.5 years and were randomized using the closed envelope method into two groups of 50 patients each. Group I patients received intra-operative intravenous (IV) injection of 10 ml calcium gluconate containing 500 mg of calcium, while Group II patients did not and served as controls. Serum calcium level was measured pre-operatively, at 6 hours and at 5 days post-operatively.

Results:

The incidence of post-operative hypocalcemia was significantly lower in Group I than in Group II patients (38% versus 62%, respectively). Eighteen patients (36%) in Group I suffered from mild hypocalcemia manifested with perioral numbness, tingling and positive Chvostek's sign as compared to 28 (56%) in Group II (X²=5.944, P=0.047).

Conclusion:

From this study it may be concluded that prophylactic IV injection of calcium gluconate during total thyroidectomy is effective in lowering the risk of post-operative symptomatic hypocalcemia.

Kew words:  Hypocalcemia, thyroidectomy, benign thyroid disease

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