Reducing hypocalcemia in patients undergoing thyroidectomy for Graves’ disease with a parathyroid hormone based protocol

Introduction

Patients with Graves' disease have a high risk of post-thyroidectomy hypocalcemia. Our aim was to evaluate the postoperative outcomes of hypoparathyroidism and hypocalcemia in Graves' disease.

Methods

A prospectively maintained, single institution database was retrospectively reviewed to identify patients with Graves' Disease who had undergone total or completion thyroidectomy. The primary outcomes of interest were postoperative hypoparathyroidism and hypocalcemia and secondary outcomes included surgical complication rates. Outcomes were further stratified based on post-anesthesia care unit (PACU) measurement of parathyroid hormone (PTH) levels and preoperative thyrotoxic status.

Results

Of the 245 Graves' thyroidectomy patients identified, nearly a third of patients (32.0 ​%) were thyrotoxic preoperatively. In the PACU, 26.5 ​% of patients had a PTH <10 ​pg/mL, although 62.9 ​% of these patients had normal PTH levels two-weeks postoperatively. Postoperative hypoparathyroidism was associated with White race and hypocalcemia two-weeks post-operatively. Thyrotoxic patients were more likely to have persistent hypocalcemia.

Conclusion

In this large series of Graves' patients undergoing thyroidectomy, in which a substantial proportion of patients had uncontrolled disease, a quarter of patients had hypoparathyroidism immediately after surgery, although this self-resolved for more than half of patients.