Measurement of parathormone level in early diagnosis of hypocalcemia after total thyroidectomy

The principal complications of thyroid surgery are the injury of inferior and superior laryngeal nerves, hypocalcemia and bleeding for today. The most important reason of hypocalcemia which developing after thyroidectomy is hypoparathyroidism. Hypoparathyroidism; develops as a result of accidentally removal of the parathyroid gland located at above or rarely at the bottom of thyroid capsule, trauma of theparathyroid glandsand devascularization of parathyroids. Symptomatic hypocalcemia can be temporary on 5-30% and permanent on 1-4% of the patients. In our study, the rate of permanent hypoparathyroidism was found 4.7% while the rate of temporary hypocalcemia is 16.5% and proportions similar to those in the literature. The hospitilization of the patients for 48-96 hours is widely practiced in many centers due to hypocalcemia on patients which can postoperatively develop within 48-72 hours. Parathyroid hormone measurement is an effective parameter for the patients who applied total thyroidectomy in the early postoperative period and thus provides safe discharges to their home after 24 hours at most. In our study, While the PTH values which are the postoperatively measured on the 20th minute, 4th hour and 24th hour are statistically being founded significant in terms of early detection of hypocalcemia (p:0,0001), a significant difference couldn't be found between the three PTH values as statically (p>0.05). The patients were discharged by looking at the values of PTH within 24 hours. Patients have parathormone level (15-65 ph/ml) < 10 ph/ml have been hospitalizied one more day, treated with intravenous calcium replacement and discharged with 2-5 g/day calcium carbonat and 0,5-1 µg/day calsitriol treatment. Patients have PTH level 10-20 pg/ml were discharged only with calcium carbonat. Patients have PTH level above 20 pg/ml weren't given any treatment. In our study, postoperative calcium values were not significant for early detection of hypocalcemia after total thyroidectomy. Although Calcium measurement in the diagnosis of symptomatic hypocalcemia was founded more economical than parathyroid hormone measurement, the follow-up study by the measurement of PTH were found more effective compared with the follow-up by the measurement of calcium. With postoperative PTH values measured on the 20th minute, patients will be safely discharged on the 24th hour and we believe that patients will not come across with the postoperative symptoms of hypocalcemia in the presence of PTH values more than 10 pg/ml. Key words: Total thyroidectomy, hypocalcemia, parathyroid hormone.