Abboud et al identified risk factors for hypocalcemia after thyroidectomy. These factors can help identify patients who may benefit from closer monitoring and oral calcium replacement therapy. The authors are from Saint Joseph University in Beirut, Lebanon.


The authors routinely performed autotransplantation when doing a bilateral thyroidectomy.


Risk factors for hypocalcemia after thyroidectomy based on multivariate analysis:

(1) elevated free thyroxine level prior to surgery

(2) bilateral thyroidectomy

(3) parathyroid autotransplantation


Protocol in thyroidectomy patients:

(1) Measure calcium 24 hours after surgery.

(2) If hypocalcemia is present then give oral calcium supplements if one or more of the risk factors is present even if the patient is asymptomatic.


Most patients in their series (90%) with hypocalcemia after surgery had become normocalcemic within a few months of surgery. It usually takes some time for autotransplanted parathyroid glands to become revascularized or for residual parathyroid tissue to undergo hyperplasia.


NOTE: Patients at risk for removal of all the parathyroid glands underwent parathyroid autotransplantation. I would imagine that failure to perform autotransplantation would place the patient at risk for permanent hypocalcemia.


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