PRESERVING UPPER PARATHYROID GLANDS BILATERALLY TO AVOID POSTOPERATIVE HYPOCALCEMIA
DOI:
https://doi.org/10.5281/zenodo.7261405Abstract
Post-surgical hypoparathyroidism occurs as hypocalcemia and may be due to multiple mechanisms,
including surgery or thyroid gland related. We planned a prospective study to determine the patients
at risk for post-surgical hypocalcemia. In the study, there were 45 patients with multinodular goiter,
euthyroid, healthy, or with mild diseases who were classified as level I or II according to the ASA
Physical Status Classification System (ASA). In addition to the demographics, preoperative and
intraoperative (right before closing), PTH levels, and postoperative total and ionized calcium levels
on the 6th and 24th hours were recorded. The patients were divided into two groups. In the first group
with 25 patients, parathyroid glands were bilaterally preserved. In the second group with 20 patients,
one of the left or right upper parathyroid glands was preserved. Kocher’s incision surgical technique
was used in the subtotal thyroidectomy operations. Preoperative total calcium levels, not showing any
difference in the preoperative samples, differed significantly in the postoperative sixth and 24th hours
(p=0.02 and p=0.001, respectively). Despite a similar association in the ionized calcium levels at the
24th hour (p=0.002), the samples taken at the sixth hour did not differ significantly. In the analysis of
the correlation between the patients expressing hypocalcemia symptoms and measured ionized
calcium levels, there was a significant difference in the samples obtained at the postoperative 24th
hour (p=0,033), with four patients presenting symptoms in group 2 compared to none in group 1. The
significant association in the analysis of the correlation between the patients expressing hypocalcemia
symptoms and measured ionized calcium levels at the postoperative 24th hour suggested that in
addition to a careful dissection, the upper parathyroid glands may be preserved bilaterally in order to
avoid postoperative hypocalcemia.
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