Evaluation of risk factors of postoperative Hypocalcemia following total Thyroidectomy: A study from tertiary care hospital.

Abstract

Objective: To evaluate the risk factors and assess the prevalence of postoperative hypocalcemia in patients having a
complete thyroidectomy at a Karachi tertiary care hospital.
Methodology: The ENT Department at Sir Syed Hospital in Karachi conducted this retrospective study from March 2022
to February 2025, over a span of three years. A total of 108 patients who underwent complete thyroidectomies had their
medical records reviewed. The collected data included postoperative biochemical outcomes, details of the surgery, diagnoses,
and demographic characteristics. Hypocalcemia was defined as total serum calcium levels below 8.0 mg/dl
within 48 hours post-surgery. The statistical analysis employed multivariate logistic regression and chi-square tests to
determine independent variables.
Results: The incidence of postoperative hypocalcemia was noted in 37 patients, representing 34.3% of the total 108 patients.
Factors significantly linked to hypocalcemia included female gender (p=0.032), central neck dissection (p=0.01),
Hashimoto's thyroiditis (p=0.004), and unintentional parathyroidectomy (p<0.001). The multivariate analysis identified
the following independent predictors: Hashimoto's thyroiditis (OR: 3.1, 95% CI: 1.3–7.5), central neck dissection (OR:
2.8, 95% CI: 1.2–6.7), and excision of the parathyroid gland (OR: 5.2, 95% CI: 2.1–12.9)
Conclusion: Following a total thyroidectomy, postoperative hypocalcemia is a common consequence. The risk can be
decreased by preserving the parathyroid glands, minimizing central dissection, and meticulously identifying thyroiditis.

Keywords: Hypocalcemia, total thyroidectomy, parathyroidectomy, central neck dissection, thyroiditis.