Vol.20 No.4

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Journal of the Arab Board of Health Specializations Vol. 20, No. 4, 2019and subtotal thyroidectomy for 68% of patients, asshown in Table 2 .Among the 5 patients with total thyroidectomy, 4%was diagnosed as CA, 4% as Grave's disease and 2%as toxic nodular goiter. While among those with neartotal thyroidectomy 10% was from MNG group, and2% with thyroiditis, 6% with Grave's disease and 4%with toxic nodular goiter.Finally; for subtotal thyroidectomy, 60% had MNG,while 4% was had thyrpoiditis, 2% was diagnosed asGrave’s disease, and another 2% as toxic nodular goiter.Around 30% of patients developed hypocalcaemiapostoperatively; in 24% of them it was transient,and in 6% was permanent. There was 1 out of the 3patients who developed permanent hypocalcaemia hadunderwent total thyroidectomy, and the other one hadunderwent near total thyroidectomy, and the last patienthad underwent subtotal thyroidectomy, Table 3.All the patients with CA had post thyroidectomyhypocalcemia, while 66.66% of patients withthyroiditis had hypocalcemia, 33.33% of those withGrave’s disease had hypocalcemia, 50% of thosewith toxic nodular goiter had hypocalcemia and only20% of those with simple multi-nodular goiter hadhypocalcemia.There were 11 patients out of the 12 (91.66%) whodeveloped transient hypocalcemia were females, and 2patients out of the 3 (66.66%) who developed permanenthypocalcaemia were females also. While one patientout of 12 (8.3%) who develop transient hypocalcemiawere male and one patient out of the 3 (33.3%) whodeveloped permanents hypocalcemia were male also, asshown in Figure 1.All of the patients who underwent total and neartotal thyroidectomy, 16 patients had underwent bilateralligation of the inferior thyroid artery, 10 patients ofthem (66.6%) had hypocalcemia, while 15 patients outof the 34 who underwent subtotal thyroidectomy hadunderwent a unilateral ligation of the inferior thyroidartery, and only 5 of them (33.4%) had hypocalcemiapostoperatively. All the 4 patients who developedType of surgeryTransientHypocalcaemiaPermanentNo hypocalcaemiaNumber & % ofpatientsTotal thyroidectomy 3 (6%) 1 (2%) 1 (2%) 5 (10%)Near total thyroidectomy 4 (8%) 1 (2%) 6 (12%) 11 (22%)Subtotal thyroidectomy 5 (10%) 1 (2%) 28 (56%) 34 (68%)Total 12 (24%) 3 (6%) 35 (70%) 50 (100%)Table 3. Distribution of cases according to the type of the surgical procedureand the occurrence of hypocalcaemia.عنوان المحورMaleFemaleTransientHypocalcemiaPermanentHypocalcemiaFigure 1. Distribution of hypocalcaemia and gender.11

Journal of the Arab Board of Health Specializations Vol. 20, No. 4, 2019hypocalcemia following total thyroidectomy were ofnormal or under normal muscular build, with only onepatient out of the 5 who had hypocalcemia followingnear total thyroidectomy was obese and of a short neck,and one patients out of the 6 who had hypocalcemiafollowing subtotal thyroidectomy were obese and of ashort neck also.DISCUSSIONPostoperative hypocalcemia is a relatively commoncomplication of thyroid surgery, and is known asa major cause of postoperative morbidity but mostoften it is a transient event that occurs after extensivethyroid surgery. The result of this study showed that theincidence of post-thyroidectomy hypocalcaemia is 30%and that it was transient in the majority of the cases.One third of the patients who had transienthypocalcemia (33.3%) and two thirds of the patientswho had permanent hypocalcemia (66.6%) belongto the 31-40 years age group, which is nearly similarto the results of Chaudhary, et al study. 1 Most of thepatients who had transient hypocalcemia (91.7%), andmost of the patients who had permanent hypocalcemia(66.7%) were females, which is similar to the results ofThomusch, et al study. 9Regarding the type and extent of the surgicalprocedure, we found that the incidence of transienthypocalcaemia was 60% after total thyroidectomy,36.3% after near-total thyroidectomy, and only 14.7%after subtotal thyroidectomy. The incidence of permanenthypocalcemia was 20% after total thyroidectomy, 9%after near-total thyroidectomy and only 2.9% aftersubtotal thyroidectomy. These figures are consistentwith those reported in other studies (Chaudhary, et aland Nair et al, and Wingert DJ, et al), which showedthat the extent of resection and surgical technique hasa greater impact on the rate of post-thyroidectomyhypocalcaemia. 1,10,11Regarding the ligation of the inferior thyroid artery,the current study found that (66.6%) of the patientswho underwent bilateral ligation of that artery hadpost-thyroidectomy hypocalcaemia, while (33.4%)of the patients who underwent a unilateral ligationof that artery had hypocalcaemia, so making thatprocedure as an important risk factor. This result wasdue to the inadvertent excision of parathyroid glandin total thyroidectomy and belong to the 31-40 yearsage group the interference with the blood supply of theparathyroid gland in case of truncal inferior thyroidartery ligation. 12,13Regarding the clinical and the pathologicaldiagnosis, the current study found that all the patientswith CA had post thyroidectomy hypocalcemia, while66.66% of patients with thyroiditis had hypocalcemia,and only 33.33% of those with Grave’s disease hadhypocalcemia, and 50% of those with toxic nodulargoiter had hypocalcemia and only 20% of those withsimple multi-nodular goiter had hypocalcemia. Thesefindings are in agreement with other studies showedthat the thyroid cancer is a risk factor for inadvertentparathyroid excision. 9,10,14 This was due to the radicalremoval of thyroid tissue, excessive dissection andtruncal ligation of inferior thyroid A.Regarding the muscular built of the patient, authorfound that only 13.3% of the patients who had postthyroidectomyhypocalcemia were obese and of a shortneck, so making that parameter is not so significant.All these factors might lead to unintentional removalof parathyroid gland and subsequent hypocalcaemia. 15,16CONCLUSIONSIt was concluded that post-thyroidectomyhypocalcemia is relatively common phenomenon,especially after extensive thyroid surgery, but it istransient in most of the cases. Its incidence is relatedto the extent of the surgical procedure, especially ifthis was associated with ligation of the inferior thyroidartery, and it can be only reduced using the correctsurgical procedures.REFERENCES1. Chaudhary IA, Afridi Z, Masood R, et al. To ligate or notthe inferior thyroid artery to avoid hypocalcaemia after12

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