Assessment of Serum Ionized Calcium in the Perioperative Period in Patients Undergoing Total Thyroidectomy


  • Muqdad Fuad Department of Surgery, College of Medicine, University of Diyala, Baqubah, Iraq
  • Ahmed Modher Department of Surgery, College of Medicine, University of Diyala, Baqubah, Iraq



Post-operative hypocalcemia, Thyroidectomy complications, Transient hypocalcemia


BACKGROUND: The serious complications of total and near-total thyroidectomy vary from hypocalcemia to recurrent laryngeal nerve injury to tension hematoma. Post-operative hypocalcemia is common and has an incidence of 1.3–83% in some studies.

AIM: The aim of the study is to evaluate the immediate post-operative sequence of serum-ionized calcium next to entire or close entire thyroidectomy to describe the incidence degree of hypocalcemia.

METHOD: One hundred and seventy-four (174) patients who underwent total and near-total thyroidectomy were investigated for serum-ionized calcium level preoperatively and on post-operative day (POD) 1 and 2, searching for difference in serum-ionized calcium level preoperatively.

RESULTS: There was a significant difference between pre-operative serum-ionized calcium (Ca++) level and that in POD1. The mean pre-operative ionized Ca was 1.23 ± 0.47 mmol/l, while mean ionized Ca on POD1 was 1.175 ± 0.11 mmol/l proposing decrease in mean of ionized Ca++ in POD1 (p = 0.0001). There was also a significant difference between pre-operative serum-ionized Ca++ level and that in POD2. The mean pre-operative ionized Ca was 1.23 ± 0.47 mmol/l, while the mean of ionized calcium on POD2 was 1.177 ± 0.1 mmol/l suggesting decrease in mean concentration of Ca++ in POD2 (p = 0.0001).

CONCLUSION: Significant number of patients who undergo near-total and total thyroidectomy develop decrease in the serum concentration of calcium postoperatively.


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Grzegory A, Pomorski L. Perioperative calcium and Vitamin D supplementation in patients undergoing thyroidectomy literature review. Pol Przegl Chir. 2018;90(4):46-50. PMid:30220675

Harris AS, Prades E, Tkachuk O, Zeitoun H. Better consenting for thyroidectomy: Who has an increased risk of postoperative hypocalcaemia? Eur Arch Otorhinolaryngol. 2016;273(12):4437-43. PMid:27207140

Noureldine SI, Genther DJ, Lopez M, Agrawal N, Tufano RP. Early predictors of hypocalcemia after total thyroidectomy: An analysis of 304 patients using a short-stay monitoring protocol. JAMA Otolaryngol Head Neck Surg. 2014;140(11):1006-13. PMid:25321339

Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A. Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg. 2015;102(4):359-67. Mid:25605285

Mauriello C, Marte G, Canfora A, Napolitano S, Pezzolla A, Gambardella C, et al. Bilateral benign multinodular goiter: What is the adequate surgical therapy? A review of literature. Int J Surg. 2016;28 Suppl 1:S7-12. PMid:26708850

De Palma M, Rosato L, Zingone F, Orlando G, Antonino A, Vitale M, et al. Post-thyroidectomy complications. The role of the device: Bipolar vs ultrasonic device: Collection of data from 1,846 consecutive patients undergoing thyroidectomy. Am J Surg. 2016;212(1):116-21. Mid:26349585

Sands NB, Payne RJ, Côté V, Hier MP, Black MJ, Tamilia M. Female gender as a risk factor for transient post-thyroidectomy hypocalcemia. Otolaryngol Head Neck Surg. 2011;145(4):561-4. PMid:21750342

Zobel MJ, Long R, Gosnell J, Sosa JA, Padilla BE. Postoperative hypoparathyroidism after total thyroidectomy in children. J Surg Res. 2020;252:63-8. Mid:32234570

OzemirI A, Buldanli MZ, Yener O, Leblebici M, Eren T, Baysal H, et al. Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy. North Clin Istambul. 2016;3(1):9-14. PMid:28058379

Eismontas V, Slepavicius A, Janusonis V, Zeromskas P, Beisa V, Strupas K, et al. Predictors of postoperative hypocalcemia occurring after a total thyroidectomy: Results of prospective multicenter study. BMC Surg. 2018;18(1):55. PMid:30092793

Kakava K, Tournis S, Papadakis G, Karelas I, Stampouloglou P, Kassi E, et al. Postsurgical hypoparathyroidism: A systematic review. In Vivo. 2016;30(3):171-80. PMid:27107072

Lorente-Poch L, Sancho J, Muñoz JL, Gallego-Otaegui L, Martínez-Ruiz C, Sitges-Serra A. Failure of fragmented parathyroid gland autotransplantation to prevent permanent hypoparathyroidism after total thyroidectomy. Langenbecks Arch Surg. 2017;402(2):281-7. PMid:28064342

Calò PG, Conzo G, Raffaelli M, Medas F, Gambardella C, DeCrea C, et al. Total thyroidectomy alone versus ipsilateral versus bilateral prophylactic central neck dissection in clinically node-negative differentiated thyroid carcinoma. A retrospective multicenter study. Eur J Surg Oncol. 2017;43(1):126-32. PMid:27780677

Pagana KD, Pagana TJ, Pagana TN. Mosby’s Diagnostic and Laboratory Test Reference. 14th ed. St. Louis, Mo: Elsevier; 2019. Available from: [Last accessed on 2021 May 12].

Filho E, Machry RV, Mesquita R, Scheffel RS, Maia AL. The timing of parathyroid hormone measurement defines the cut-off values to accurately predict postoperative hypocalcemia: A prospective study. Endocrine. 2018;61(2):224-31. PMid:29721800

Annerbo M, Hultin H, Stålberg P, Hellman P. Left-shifted relation between calcium and parathyroid hormone in Graves’ disease. J Clin Endocrinol Metab. 2014;99(2):545-51. PMid:24248181

Park I, Rhu J, Woo JW, Choi JH, Kim JS, Kim JH. Preserving parathyroid gland vasculature to reduce post-thyroidectomy hypocalcemia. World J Surg 2016;40(6):1382-9. PMid:27028753

Raffaelli M, De Crea C, D’Amato G, Moscato U, Bellantone C, Carrozza C, et al. Post-thyroidectomy hypocalcemia is related to parathyroid dysfunction even in patients with normal parathyroid hormone concentrations early after surgery. Surgery. 2016;159(1):78-84. PMid:26456131

Özden S, Erdoğan A, Simsek B, Saylam B, Yıldız B, Tez M. Clinical course of incidental parathyroidectomy: Single center experience. Auris Nasus Larynx. 2018;45(3):574-7. PMid:28807528

Karamanakos SN, Markou KB, Panagopoulos K, Karavias D, Vagianos CE, Scopa CD, et al. Complications and risk factors related to the extent of surgery in thyroidectomy. Results from 2,043 procedures. Hormones (Athens, Greece). 2010;9(4):318-25. PMid:21112863

Maxwell AK, Shonka DC, Jr., Robinson DJ, Levine PA. Association of preoperative calcium and calcitriol therapy with postoperative hypocalcemia after total thyroidectomy. JAMA Otolaryngol Head Neck Surg. 2017;143(7):679-84. PMid:28418509

Paduraru DN, Ion D, Carsote M, Andronic O, Bolocan A. Post-thyroidectomy hypocalcemia risk factors and management. Chirurgia. 2019;114:564-70. PMid:31670631

Kalyoncu D, Gonullu D, Gedik ML, Er M, Kuroğlu E, İğdem AA, et al. Analysis of the factors that have effect on hypocalcemia following thyroidectomy. Ulusal Cer Derg. 2013;29:171-6. PMid:25931872

Tolone S, Roberto R, Del Genio G, et al. The impact of age and oral calcium and Vitamin D supplements on postoperative hypocalcemia after total thyroidectomy: A prospective study. BMC Surg. 2013;13(2):S11. PMid:24267491

Riaz U, Shah SA, Zahoor I, Riaz A, Zubair M. Validity of early parathyroid hormone assay as a diagnostic tool for sub-total thyroidectomy related hypocalcaemia. J Coll Physicians Surg Pak. 2014;24(7):459-62. PMid:25052965

Cannizzaro MA, Lo Bianco S, Picardo MC, Provenzano D, Buffone A. How to avoid and to manage post-operative complications in thyroid surgery. Updates Surg. 2017;69(2):211-5. PMid:28646422

Bhettani MK, Rehman M, Ahmed M, Altaf HN, Choudry UK, Khan KH. Role of pre-operative Vitamin D supplementation to reduce post-thyroidectomy hypocalcemia; Cohort study. Int J Surg (London, England). 2019;71:85-90. PMid:31494332




How to Cite

Fuad M, Modher A. Assessment of Serum Ionized Calcium in the Perioperative Period in Patients Undergoing Total Thyroidectomy. Open Access Maced J Med Sci [Internet]. 2021 Oct. 2 [cited 2022 Jan. 24];9(B):1203-6. Available from: