THE EFFECT OF IN SITU PRESERVATION OF PARATHYROID GLAND ON CALCIUM LEVEL AFTER TOTAL THYROIDECTOMY
Objective: Hypocalcemia is the most common complication encountered in patients after total thyroidectomy. The study was aimed to determine the effect of insitu preservation of parathyroid gland on serum calcium levels after total thyroidectomy.
Material and Methods: This was a retrospective study carried out in the surgical department and chemical pathology department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. Data of 150 patients was collected retrospectively since 2016 -2019, who underwent total thyroidectomy and recorded their database prospectively. Study subjects were divided into three groups by number of parathyroid gland (one PTG preserved=group1, two PTG preserved=group2 and >2 PTG preserved =group3). The total calcium, magnesium, vitamin D and parathyroid hormone (iPTH) levels were compared among the three groups. Effect of this preservation on the development of transient and permanent hypocalcemia was noted.
Results: There were 28 patients in group 1, 55 in group 2 and 67 in group 3. The average age of the patients was 45.4±11.7 years in group 1, 42.7±10.2 years in group 2 and 44.8±12.5 years in group 3. There were 19 Female and 09 males in group 1, 42 Females and 13 males in group 2 and 49 female and 18 males in group 3. Pre-operative calcium level was 8.1±0.22mg/dl in group 1, 8.6±0.11mg/dl in group 2 and 8.8±0.37mg/dl in group 3. Post-operative calcium level was 7.2±.09mg/dl in group 1, 8.4±0.21mg/dl in group 2 and 8.6±0.31mg/dl in group 3 with p value <0.05. Transient hypocalcemia was developed in 53.5% patients in group 1, 10.9% in group 2 while none was observed in group 3. Permanent hypocalcemia developed in 7.1% in group 1 while no permanent hypocalcemia was seen in groups 2 and 3.
Conclusion: The incidence of hypocalcemia can be significantly reduced in-situ preservation of atleast two parathyroid glands with intact blood supply during total thyroidectomy. Lesser preservation of parathyroid glands or its auto-transplantation is independent risk factor for the development of postoperative hypocalcemia.
Key Words: Parathyroid gland, Hypocalcemia, Thyroidectomy.