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Hypocalcaemia following thyroidectomy for treatment of Graves’ disease: implications for patient management and cost-effectiveness

Published online by Cambridge University Press:  17 June 2011

O R Hughes  and
D M Scott-Coombes
O R Hughes*
Affiliation:
Department of Otorhinolaryngology, Royal National Throat, Nose and Ear Hospital, London, England, UK Molecular Immunology Unit, Institute of Child Health, University College London, England, UK
D M Scott-Coombes
Affiliation:
Department of Endocrine Surgery, University Hospital of Wales, Cardiff, Wales, UK
*
Address for correspondence: Dr Owain Hughes, Molecular Immunology Unit, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK Fax: +44 (0)207 905 2810 E-mail: [email protected]
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Abstract

Background:

No consensus exists on optimal treatment for Graves’ disease once anti-thyroid medication fails to induce remission. Total thyroidectomy is a more cost-effective treatment than radioactive iodine or life-long anti-thyroid medication, but hypocalcaemia is an important complication, leading to longer hospital admissions and increased prescription costs. This study aimed to compare the relative risk of hypocalcaemia requiring medical treatment for patients with Graves’ disease.

Methods:

Prospective cohort study of patients undergoing total thyroidectomy for Graves’ disease and for multinodular goitre, calculating serum calcium levels 24-hours post-operatively and prescription rates.

Results:

Mean corrected calcium concentrations 24 hours post-operatively were 2.05 mmol/l for Graves’ disease patients and 2.14 mmol/l for multinodular goitre patients (p = 0.003). Biochemical hypocalcaemia developed in 92 per cent (n = 34) of Graves’ disease patients and 71 per cent (n = 43) of multinodular goitre patients (p = 0.012). Graves’ disease patients were more likely to be prescribed calcium supplementation pre-discharge (p = 0.037).

Conclusion:

Total thyroidectomy for Graves’ disease carries an increased risk of hypocalcaemia at 24 hours, and of calcium supplementation pre-discharge. Graves’ disease patients should be informed of the increased risk of hypocalcaemia associated with total thyroidectomy, and this risk must be factored into future cost-effectiveness analysis.

Keywords

Graves’ DiseaseThyroidectomyHypocalcaemiaComplications
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 125 , Issue 8 , August 2011 , pp. 849 - 852
Copyright
Copyright © JLO (1984) Limited 2011

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References

1In, H, Pearce, EN, Wong, AK, Burgess, JF, McAneny, DB, Rosen, JE. Treatment options for Graves disease: a cost-effectiveness analysis. J Am Coll Surg 2009;209:170–9CrossRefGoogle ScholarPubMed
2Wong, C, Price, S, Scott-Coombes, D. Hypocalcaemia and parathyroid hormone assay following total thyroidectomy: predicting the future. World J Surg 2006;30:825–32CrossRefGoogle ScholarPubMed
3Yamashita, H, Noguchi, S, Murakami, T, Uchino, S, Watanabe, S, Ohshima, A et al. Predictive risk factors for postoperative tetany in female patients with Graves’ disease. J Am Coll Surg 2001;192:465–8CrossRefGoogle ScholarPubMed
4Escobar-Jimenez, F, Torres, EV, Picon, A, Megias, M, Moll, J. Hypocalcaemia and thyroid surgery. Lancet 1977;ii:402CrossRefGoogle Scholar
5Wilkin, TJ, Isles, TE, Paterson, CR, Crooks, J, Beck, J. Post-thyroidectomy hypocalcaemia: a feature of the operation or the thyroid disorder? Lancet 1977;i:621–3CrossRefGoogle Scholar
6Jones, RM, Davidson, CM. Thyrotoxicosis and the hungry bone syndrome: a cause of postoperative tetany. J R Coll Surg Edinb 1987;32:24–8Google ScholarPubMed
7Michie, W, Duncan, T, Hamer-Hodges, DW, Bewsher, PD, Stowers, JM, Pegg, CA et al. Mechanism of hypocalcaemia after thyroidectomy for thyrotoxicosis. Lancet 1971;i:508–14CrossRefGoogle Scholar
8Erdogan, MF, Anil, C, Cesur, M, Baskal, N, Erdogan, G. Color flow Doppler sonography for the etiologic diagnosis of hyperthyroidism. Thyroid 2007;17:223–8CrossRefGoogle ScholarPubMed
9Friguglietti, CU, Lin, CS, Kulcsar, MA. Total thyroidectomy for benign thyroid disease. Laryngoscope 2003;113:1820–6CrossRefGoogle ScholarPubMed
10Perzik, SL. Total throidectomy in the management of Graves’ disease. A review of 282 cases. Am J Surg 1976;131:284–7CrossRefGoogle ScholarPubMed
11Thomusch, O, Machens, A, Sekulla, C, Ukkat, J, Lippert, H, Gastinger, I et al. Multivariate analysis of risk factors for postoperative complications in benign goitre surgery: prospective multicenter study in Germany. World J Surg 2000;24:1335–41CrossRefGoogle ScholarPubMed
12Harrison, B, ed. The British Association of Endocrine Surgeons First National Audit Report 2003. Dendrite Clinical Systems Ltd. City: Henley-on-Thames.Google Scholar
13Moore, F. Oral calcium supplements to enhance early hospital discharge after bilateral surgical treatment of the thyroid gland or exploration of the parathyroid glands. J Am Coll Surg 1994;178:11–16Google ScholarPubMed
14Witte, J, Goretzki, PE, Dotzenrath, C, Simon, D, Felis, P, Neubauer, M et al. Surgery for Graves’ disease: total versus subtotal thyroidectomy – results of a prospective randomized trial. World J Surg 2000;24:1303–11CrossRefGoogle ScholarPubMed
15Lal, G, Ituarte, P, Kebebew, E, Siperstein, A, Duh, QY, Clark, OH. Should total thyroidectomy become the preferred procedure for surgical management of Graves’ disease? Thyroid 2005;15:569–74CrossRefGoogle ScholarPubMed
16Yamashita, H, Noguchi, S, Tahara, K, Watanabe, S, Uchino, S, Kawamoto, H et al. Postoperative tetany in patients with Graves’ disease: a risk factor analysis. Clin Endocrinol (Oxf) 1997;47:71–7CrossRefGoogle ScholarPubMed
17Yamashita, H, Murakami, T, Noguchi, S, Shiiba, M, Watanabe, S, Uchino, S et al. Postoperative tetany in Graves disease: important role of vitamin D metabolites. Ann Surg 1999;229:237–45CrossRefGoogle ScholarPubMed
18Laitinen, O. Hypocalcaemia after thyroidectomy. Lancet 1976;ii:859–60CrossRefGoogle Scholar