Hypocalcemia Following Thyroid Surgery

Abstract

Background: Postoperative hypocalcemia is a common thyroidectomy complication, especially after total thyroidectomy. Recognizing its incidence, risk factors, and resolution is key to optimizing patient care. Methods: This prospective observational study was conducted at Department of Otolaryngology-Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from October 2021 to March, 2022 to evaluate the incidence, risk factors, and clinical manifestations of hypocalcemia following thyroid surgery. A total of 50 patients undergoing total thyroidectomy and subtotal thyroidectomy for benign or malignant thyroid conditions were included. Results: Postoperative hypocalcemia was observed in 18 patients (36%), with total thyroidectomy (p = 0.032), malignant thyroid diagnosis (p = 0.038), and intraoperative blood loss >100 mL (p = 0.045) significantly associated with increased risk. Parathyroid preservation significantly reduced hypocalcemia risk (p = 0.012), while lack of preservation was associated with higher hypocalcemia rates (p = 0.008). Serum calcium levels significantly improved from POD 1 (8.2 ± 0.6 mg/dL) to POD 5 (8.8 ± 0.5 mg/dL, p = 0.034), with symptomatic hypocalcemia decreasing from 30% on POD 1 to 14% on POD 5 (p = 0.029). Surgery duration >2 hours showed a trend toward increased hypocalcemia risk but was not statistically significant (p = 0.067). Conclusion: Postoperative hypocalcemia is a common but transient complication of thyroidectomy, with total thyroidectomy, malignancy, and poor parathyroid preservation as key risk factors. Careful monitoring, early calcium supplementation, and perioperative parathyroid preservation can minimize its incidence and improve its outcomes.