Objective: To determine the association of surgeon’s experience based on years of practice and incidence of post thyroidectomy hypocalcemia. Methods: Design: Retrospective cohort study. Setting: Tertiary Private Training Hospital. Participants: Records of patients who underwent total thyroidectomy in a private tertiary hospital from January 2003 to December 2018 were retrospectively reviewed. Medical information obtained were patient demographics, surgeon’s years of practice, thyroid specimen weight, technique of surgery, histopathologic findings and calcium assay values. Chi square test and Odds Ratio analysis were used to determine the relationship between the surgeon’s experience and post-thyroidectomy hypocalcemia. Results: Three hundred fourteen (314) patients who underwent total thyroidectomy from 2003 to 2018 were included in the study. Overall rate of post-operative hypocalcemia was 41%. On multivariate analysis, no significant odds ratio was found between surgeons with 5 to 19 years of experience and those with more than 19 years of experience in relation to post-operative hypocalcemia [Odds Ratio 1.4 (95% Confidence Interval 0.7 to 2.6)]. Odds ratios for other variables may be interpreted, however, they could not be generalized over the population where data was gathered since the 95% Confidence Interval includes 1. Conclusion The results of this retrospective cohort study suggest that post-thyroidectomy hypocalcemia is not associated with surgeon’s experience based on years of practice. Further studies are recommended in a multicenter approach to better generalize to the whole population.
Thyroidectomy ; Hypocalcemia ; Postoperative Complications

Arrhythmias, Cardiac ; etiology ; Birth Weight ; Electrocardiography ; Female ; Humans ; Hypocalcemia ; complications ; Infant, Newborn ; Male

BACKGROUND AND OBJECTIVES: Parathyroid dysfunction following a total or completion thyroidectomy is not uncommon and it may be associated with significant patient morbidity. If there is a simple test with proven high predictability for identifying which patients will develop hypocalcemia, it would be very useful to determine the necessities of careful monitoring and calcium replacement. The purpose of this study is to determine which test would be the most valuable predictor of post-thyroidectomy hypocalcemia. SUBJECTS AND METHOD: Prospective series of 63 consecutive patients undergoing total or completion thyroidectomy were enrolled for this study. Calcium and ionized calcium were measured before and immediately after surgery, and daily during hospitalization. Parathyroid hormone (PTH) was measured immediately after surgery and early in the morning of the next day. Slopes of serum calcium, ionized calcium and PTH level change were calculated. Sensitivity, specificity and predictive values of each test for the symptomatic and biochemical hypocalcemia were compared. RESULTS: With the cut-off value of 10 pg/ml of spot PTH, sensitivity, specificity, positive and negative predictive values of hypocalcemia were 97%, 64%, 77% and 95% respectively. By combining the spot PTH and the slope of ionized calcium change, the above values became 94%, 82%, 87% and 92%. CONCLUSION: Immediate postoperative spot PTH level was the most valuable single test for predicting post-thyroidectomy hypocalcemia. Combination of a spot PTH and the slope of ionized calcium change resulted in improved specificity and positive predictability.
Calcium ; Early Diagnosis ; Hospitalization ; Humans ; Hypocalcemia* ; Parathyroid Hormone* ; Postoperative Complications ; Prospective Studies ; Sensitivity and Specificity ; Thyroidectomy

OBJECTIVE: To investigate the application value of parathyroid hormone (PTH) within 24 hours in predicting post-operative hypocalcemia after total thyroidectomy. METHOD: In this study, we selected 207 consecutive patients, performed total thyroidectomy in our hospital, measured the serum PTH and electrolyte, divided them into subgroups according to the definition of post-operative hypocalcemia, and made the ROC curves analysis combining with clinical data. RESULT: The mean value of pre-operative PTHs between groups. show no significant difference (P > 0.05); in the first day after surgery, the post-operative hypocalcemia group have a significant lower average PTHs (P < 0.01). ROC area under the curve (AUC) of day-1 is 0.886, with the PTH cutoff value 16. 8 pg/ml. CONCLUSION The PTH within 24 hours is an important indicator to judging post-operative hypocalcermia after total thyroidectomy.
Humans ; Hypocalcemia ; blood ; Parathyroid Hormone ; blood ; Postoperative Complications ; blood ; Thyroidectomy ; adverse effects

To review the diagnosis and treatment of a case of hypercalcium crisis caused by primary hyperparathyroidism（PHPT） and prophylactic treatment of hungry bone syndrome. In a 32-year-old male with hypercalcemia, the main manifestations were loss of appetite, nausea, polyuria, polydipsia, fatigue, lethargy, etc. parathyroid hormone, serum calcium increased, thyroid function was normal, thyroid color ultrasound and MRI showed space-occupying behind the right thyroid, radionuclide examination showed abnormal imaging agent concentration in the right parathyroid area, there was a history of pathological fracture. Clinically diagnosed as hypercalcemia crisis secondary to PHPT.
Male ; Humans ; Adult ; Hypercalcemia/diagnosis* ; Hyperparathyroidism, Primary/surgery* ; Parathyroid Hormone ; Hypocalcemia/complications* ; Thyroid Gland ; Calcium

The metabolic alterations caused by hyperaldosteronism are being increasingly recognized and have generated considerable interest among the medical fraternity. Hyperaldosteronism is suspected to have a pivotal role in the patho-physiology of congestive cardiac failure where it has been studied extensively. But its effects on calcium metabolism, parathyroid metabolism and renal handling of calcium are less well described. Recent experimental models have shed light into the roles played by previously unknown mechanisms in causing these metabolic alterations. We hereby report a case of primary hyperaldosteronism due to adrenal adenoma (Conn's syndrome) who presented with a myriad of clinical features including symptomatic hypocalcemia, significant weight loss along with uncontrolled hypertension for a prolonged period before eventually detected to have primary hyperaldosteronism. Surgical removal of the causative tumor resulted in prompt disappearance of all the symptoms and signs and regain of lost weight.
Adrenal Cortex Neoplasms/*complications/diagnosis/pathology/surgery ; Adrenocortical Adenoma/*complications/diagnosis/pathology/surgery ; Adult ; Female ; Humans ; *Hyperaldosteronism/complications/etiology/physiopathology ; Hypocalcemia/*etiology ; Pregnancy ; Treatment Outcome

PURPOSE: Subtotal thyroidectomy has been the standard operation for Graves' disease in achieving a favorable outcome in recovery of euthyroid state. However, the postoperative outcomes following subtotal thyroidectomy differ by surgeon and postoperative thyroid dysfunctions develop as time passes. Here, we have studied the validity of total thyroidectomy for Graves' disease patients, with a comparison to subtotal thyroidectomy. METHODS: A total of 299 patients with Graves' disease underwent thyroid operation consecutively in Asan Medical Center, Seoul, Korea from December 1995 to December 2005. Among them, 241 cases had subtotal thyroidectomy and 43 had total thyroidectomy. The subtotal thyroidectomy cases were divided into 3 groups according to estimated remnant thyroid; <4 g, 4< or =~<6 g and > or =6 g. Also, according to postoperative thyroid function, the patients were divided into euthyroid, hypothyroidism and hyperthyroidism groups. The postoperative changes of thyroid function, postoperative complications and hospital days were analyzed. RESULTS: In subtotal thyroidectomy, postoperative thyroid function showed euthyroid in 25 (10.4%), hypothyroidism 206 (85.5%) and hyperthyroidism 10 (4.1%). However, total thyroidectomy showed no persistent hyperthyroidism or recurrence. The postoperative thyroid function state changed in 24 patients out of 148 who had more than 2 years postoperative follow-up. Hyper-functional changes developed with higher rates (Hypo-6 vs. hyper-18). The postoperative complication rate was higher in subtotal thyroidectomy including bleeding, hoarseness and hypocalcemia. CONCLUSION: In our study, the patients showing normal thyroid function after subtotal thyroidectomy were very limited and thyroid dysfunction developed continuously with time lapse, especially towards hyperthyroid state. Therefore, we suggest that total thyroidectomy should be considered as a treatment option in Graves' disease.
Follow-Up Studies ; Graves Disease ; Hemorrhage ; Hoarseness ; Humans ; Hyperthyroidism ; Hypocalcemia ; Hypothyroidism ; Korea ; Postoperative Complications ; Recurrence ; Thyroid Gland ; Thyroidectomy

PURPOSE: Completion thyroidectomy is defined as the surgical removal of the remnant thyroid tissue following procedures less than total thyroidectomy. However the roles and indications of completion thyroidectomy remain controversial. This study was performed to review the clinical and pathologic features of patients who underwent completion thyroidectomy and to evaluate the safety of this procedure. METHODS: A retrospective analysis from Nov. 1994 to Dec. 2002 at Samsung Medical Center yielded 36 patients, 11 male and 25 female, who had undergone completion thyroidectomy. Their median follow-up was 29 months. RESULTS: The patients ranged in age from 20 to 58 years. Of the 36 patients, 24 had undergone prophylactic thyroidectomy and 12 therapeutic thyroidectomy for recurrence. The most common cause of completion thyroidectomy was cancers undiagnosed during the primary operation and 12 cases (75%) among these 16 undiagnosed cancers were follicular carcinoma. Three patients harbored carcinoma at the perithyroidal lymph node or remnant thyroid as a result of prophylactic completion thyroidectomy. Postoperative complications occurred in 11 patients (31%): 10 transient hypocalcemia and 1 transient hoarseness. There were no differences in postoperative complication rate between total thyroidectomy group and completion thyroidectomy during the same period at our hospital. CONCLUSION: The most common indication that is considered for completion thyroidectomy is a follicular carcinoma undiagnosed during primary operation. Completion thyroidectomy might be a safe operation with minimal morbidity if it is performed meticulously by an experienced surgeon.
Female ; Follow-Up Studies ; Hoarseness ; Humans ; Hypocalcemia ; Lymph Nodes ; Male ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms* ; Thyroidectomy*

PURPOSE: A completion thyroidectomy after less than total thyroidectomy is needed for the treatment of recurrent papillary thyroid carcinoma (PTC). The aim of this study is to evaluate the clinicopathological features and the postoperative complications of completion thyroidectomy for patients with recurrent PTC. METHODS: A total 94 PTC patients who had undergone prior less than total thyroidectomy underwent completion thyroidectomy for recurrence from March 1986 to June 2009. We retrospectively analyzed the clinicopathological features and postoperative complications. RESULTS: At the initial operation, the patients' mean age was 38.2 years old. Central node metastasis was found in 37 cases and extrathyroidal invasion was found in 12 cases. The mean interval time between the initial operation to the completion thyroidectomy was 76.6 months. Fifty six patients underwent completion thyroidectomy only and 38 underwent a completion thyroidectomy combined with a modified radical neck dissection. In the combined group, central neck node metastasis and extrathyroidal invasion at the time of the initial operation were significantly more frequent than those in the completion thyroidectomy only group. The postoperative complications were 14 cases of transient hypocalcemia and 8 cases of permanent hypocalcemia and there were no significant differences between the two groups. CONCLUSION: When performing completion thyroidectomy, it is important to check the lateral neck nodes for metastasis when central neck node metastasis or extrathyroidal invasion were present at the initial operation, and this can be done safely without severe complications even though it is combined with modified radical neck dissection.
Humans ; Hypocalcemia ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Postoperative Complications* ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy*

BACKGROUND: The optimal extent of thyroid resection in Graves' disease has not been clearly determined. A significant proportion of patients experience recurrence of the disease after subtotal thyroidectomy. Total thyroidectomy can eliminate the source of the disease. However, many surgeons are reluctant to conduct a total thyroidectomy because it has been known to be associated with increased postoperative morbidity. METHODS: Thirty-six patients underwent subtotal thyroidectomy (ST, n=19) or total/near total thyroidectomy (T/NT, n=17) for Graves' disease after treatment with antithyroid drugs. Relapse of the hyperthyroidism, surgical complications, and serum calcium levels were evaluated. RESULTS: Operation time was not prolonged by the extent of thyroidectomy (ST: 106+/-32.1 min., T/NT: 118+/-34.3 min.). Transient hypocalcemia was observed in 5 patients (29.4%) after a total or a near total thyroidectomy, whereas 3 patients (15.7%) experienced transient hypocalcemia after a subtotal thyroidectomy. All patients showed normal serum calcium level 1 month after the operation and had become free of hypocalcemic symptoms. No patient had injury to the recurrent laryngeal nerve, regardless of the extent of the surgery. Recurrence of the hyperthyroidism was observed in 3 patients who had undergone a subtotal thyroidectomy. CONCLUSIONS: Total thyroidectomy can be conducted safely in patients with Graves' disease without any increase in postoperative complications, such as hypoparathyroidism or injury to the recurrent laryngeal nerve. Therefore, total thyroidectomy appears to be an effective alternative treatment modality for Graves' disease.
Antithyroid Agents ; Calcium ; Graves Disease* ; Humans ; Hyperthyroidism ; Hypocalcemia ; Hypoparathyroidism ; Postoperative Complications ; Recurrence ; Recurrent Laryngeal Nerve ; Thyroid Gland ; Thyroidectomy*