Introduction and objective:

Given the increasing number of thyroid surgeries, the incidence of post-surgical hypoparathyroidism is on the rise. The frequency of hypocalcaemia due to hypoparathyroidism after total thyroidectomy is highly variable according to the literature (0.3-68%). The primary objective of this study is to analyze the biochemical, surgical and demographic factors related to an increased risk of hypocalcaemia.

Methodology:

This retrospective study encompasses 297 patients who underwent total thyroidectomy over a period of 8 years in a tertiary hospital. Demographic, clinical and biochemical data, both preoperative, intraoperative and postoperative, and their relationship with postoperative hypocalcaemia are analyzed.

Results:

The rate of total hypocalcaemia was 40.2%, being transient in 26.1%. Statistically significant variables were age (p=0.04), Graves' disease (p=0.04), carcinoma confirmed by pathology (p=0.04), two-stage thyroidectomy (p=0.00), the number of transplanted parathyroids (p=0.00) and pre- and post-operative PTH (p=0.03 and p=0.00) and the PTH gradient (p=0.00).

Conclusions:

This study demonstrates that there are a series of risk factors intrinsic to the patient and to the surgical procedure capable of predicting the risk of hypocalcaemia after total thyroidectomy. Possibly, the optimization of the surgical technique could prevent the appearance of hypocalcaemia after total thyroidectomy in some cases, while in others, the identification of these factors post-op could allow early detection and effective treatment of these patients. In the present study, age, Graves' disease, and parathyroid autotransplantation were associated with postoperative hypocalcemia. Thyroid carcinoma and two-stage thyroidectomy were protective factors.

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