Incidence and predictive factors of postoperative hypocalcaemia according to type of thyroid surgery in older adults

Abstract

Transient hypocalcaemia after thyroid surgery and its possible predictors have not been extensively described in the elderly. This study aimed to establish the frequency of postsurgical transient hypocalcaemia according to the extent of thyroid surgery in older adults and to assess mineral metabolism biochemical parameters as its predictors. All patients ≥60 years undergoing thyroid surgery were prospectively included. Type of surgery (hemithyroidectomy(HT) or total thyroidectomy(TT)); and preoperative 25OH Vitamin D (25OHD) and pre and 6 (only TT), 24\u2009h and 6 months postsurgical serum levels of calcium, magnesium, phosphate and parathormone (PTH) were considered. Postsurgical hypoparathyroidism (hPTpost) was defined at PTH levels ≤11\u2009pg/mL. Out of 46 patients (87% female), age (mean\u2009±\u2009SD) 70.1\u2009±\u20096.2 years, 24\u2009h postsurgical hypocalcaemia was found in ten patients (22%). In 25 (54%) TT patients, 36% and 16% had postsurgical hypocalcaemia at 6 and 24\u2009h respectively; 28% hPTpost but no definitive hPT was recorded and 44% had 25OHD deficiency. Lower 24\u2009h magnesium levels were found in those TT patients with 24\u2009h hypocalcaemia (1.6\u2009±\u20090.1 vs 1.9\u2009±\u20090.1\u2009mg/dL (p\u2009=\u20090.005)). Among 21 (46%) HT patients, 28.6% had 24\u2009h postsurgical hypocalcaemia; 9.5% had hPTpost. A positive correlation was observed between preoperative 25OHD and 24\u2009h calcaemia (r:0.51,p\u2009=\u20090.02). 43% of the patients were 25OHD deficient, in whom 55% had 24\u2009h hypocalcaemia vs only 9% in the 25OHD sufficient group (p\u2009=\u20090.049). Postsurgical hypocalcaemia was common in elderly thyroidectomized patients. After TT, lower magnesium levels were found in those patients with 24\u2009h hypocalcaemia. In the HT group, preoperative 25OHD deficiency predicted lower postsurgical calcium levels.