Exploring Post-Thyroidectomy Hypocalcemia in the Background of Thyroiditis- A Comparative Study.

Abstract

Thyroid surgery once referred to as "horrid butchery" due to its high risk and complexity, has transformed dramatically over the centuries. Advances in surgical techniques, along with improvements in hemostasis and nerve identification technologies, have significantly reduced the mortality associated with thyroidectomy. The advent of intraoperative nerve monitoring and visual identification using reliable anatomical landmarks has made the identification and preservation of the recurrent laryngeal nerve almost routine. However, despite these advancements, the intricate design, variable anatomy, and crucial functionality of the parathyroid glands continue to pose significant challenges, even for the most experienced and high-volume surgeons. The aim of our retrospective study is to investigate the association between thyroiditis (histopathologically diagnosed) and the occurrence of hypocalcemia in our patients who have undergone total thyroidectomy. A total of 223 patients were analyzed, divided into two groups: 102 patients without thyroiditis and 121 patients with thyroiditis. The incidence of the postoperative hypocalcemia was compared between these two groups. We have performed the statistical analysis to determine if there were any significant differences noted in the occurrence of hypocalcemia between the two groups. In the non-thyroiditis group, hypocalcemia developed in 50 of 102 patients (49.0%). In the thyroiditis group, hypocalcemia occurred in 67 of 121 patients (55.4%). Chi-square test was used to analyze the data, yielding a p-value of 0.417, which indicates no statistically significant difference in the post operative hypocalcemia incidence between patients with and without thyroiditis. Patients with thyroiditis exhibit a higher incidence of hypocalcemia, though not statistically significant compared to non-thyroiditis cases. Preoperative identification of thyroiditis, expert surgical guidance, and emphasis on tactile feedback while tissue handling reduce the risks of post-thyroidectomy hypoparathyroidism, ensure patient safety and optimal surgical outcomes.