Am J Otolaryngol Head Neck Surg | Volume 6, Issue 6 | Research Article | Open Access

Total Thyroidectomy: Is there a Link between Thyroid Pathology and Secondary Hypocalcemia?

Lamirand B1*, Hitier M1, Joubert M2, Bastit V1 and Babin E1

1Department of Otolaryngology-Head and Neck Surgery, Caen University Hospital, France
2Department of Endocrinology and Metabolic Disorders, Caen University Hospital, France

*Correspondance to: Lamirand B 

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Introduction: Early and persistent hypocalcemia is a complication of total thyroidectomy. Our study aims to investigate the variations of this biological marker according to the nature of the operative indication. Materials and Methods: A single-center, retrospective study was carried out over a 4-year period. A total of 282 patients undergoing total thyroidectomy were included in the study. The operative indications were: Malignant tumor (45 patients), thyrotoxicosis (105 patients) or compressive goiter (132 patients). Objectives: The primary objective of the study was to determine whether patients with toxic goiter had a significantly higher risk of developing hypocalcemia at different postoperative time points (at 2 days then 1 and 6 months). The secondary objectives were to investigate the association between the discovery of incidental parathyroid on histological examination of the specimen and secondary hypocalcemia, to assess the risk of secondary hypocalcemia according to the ligation technique used, and to determine the risk factors for hypocalcemia at different postoperative times. Results: Early hypocalcemia was observed in 83 patients (30.15%). It persisted at 1 month in 22 patients (8%) and at 6 months in 8 patients (2.8%). Patients operated on for toxic goiter showed a significant decrease in early Calcemia (p=0.015), but no significant decrease at 1 month (p=0.14) or 6 months (p=0.09) compared to patients operated on for compressive goiter. There were no more incidental parathyroid removals in the group of patients operated on for toxic goiter than in those operated on for compressive goiter (p=0.96). The number of incidental parathyroidectomies was higher in the malignant group than in the toxic goiter group (p=0.04). There was significantly more early hypocalcemia at D2 when using LigaSure compared to wire or clip ligation (p=0.020). Factors significantly associated with an increased risk of permanent hypocalcemia at 6 months were lower mean age (41.4 ± 16.2 years vs. 53.1 ± 15.6 years; p=0.037), the presence of one or more parathyroids on pathology (p=0.017), the existence of symptomatic hypocalcemia (p<0.001), or rehospitalization for hypocalcemia (p=0.001). Conclusion: Our study shows an increased risk of early hypocalcemia in patients undergoing total thyroidectomy for thyrotoxicosis and when using the LigaSure. The risk of parathyroid devascularization in patients with toxic goiter warrants careful dissection and coagulation during surgery


Total thyroidectomy; Secondary hypocalcemia; Thyrotoxicosis; Ligation technique; Permanent hypocalcemia


Lamirand B, Hitier M, Joubert M, Bastit V, Babin E. Total Thyroidectomy: Is there a Link between Thyroid Pathology and Secondary Hypocalcemia?. Am J Otolaryngol Head Neck Surg. 2023;6(6):1246.

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