Endocrine Abstracts (2009) 19 S15

Diagnosis and management of post-operative hypocalcaemia following (para)thyroidectomy

NJL Gittoes

University of Birmingham, Birmingham, UK.

With limited UK health resources and a drive to minimise risk of hospital-acquired infections, there is continual striving to reduce length of stay for all in patient procedures. Increasing numbers of elective surgical procedures are carried out as day cases. Many centres adopt minimally invasive parathyroidectomy (carried out as a day case) as the preferred treatment for primary hyperparathyroidism and there is pressure to minimise post-operative length of stay following thyroidectomy.

Hypocalcaemia following (para)thyroidectomy may be temporary or permanent. The risk of hypocalcaemia in the early post-operative period following total thyroidectomy was reported to be ~32% in the British Association of Endocrine Surgeons 2007 National Audit. There are clinical and biochemical predictors of post-operative hypocalcaemia but these are not fully sensitive or specific, to the extent that all patients following (para)thyroidectomy carry a finite risk of hypocalcaemia. Key to safe and efficient management of patients undergoing (para)thyroidectomy is the ability to rapidly assess and treat potential hypocalcaemia.

There is no consensus algorithm or guideline that proactively dictates the management of hypocalcaemia following (para)thyroidectomy, instead local practices prevail that tend to be reactive to significant clinically relevant hypocalcaemia. Various strategies have been employed to manage calcium homeostasis following (para)thyroidectomy that to a large extent have been devised within surgical specialities. Some employ pre-operative prophylactic treatment while others rely on early and frequent post-operative monitoring of calcium (and sometimes PTH) concentrations.

This session will review current approaches to the acute assessment and management of post-operative hypocalcaemia, emphasising the role, timing, and chronicity of use of intravenous calcium supplementation, oral calcium supplements, and use of active vitamin D metabolites. Effective monitoring for post-operative hypocalcaemia will be discussed and a proposed proactive algorithm for assessment and treatment of (para)thyroidectomy-induced hypocalcaemia will be proposed.

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