Prevention of postoperative hypocalcemia in patients with thyrotoxicosis

Abstract

A significant increase in the cases of diffuse toxic goiter (DTG) in Ukraine leads to the increased number of surgical interventions for the thyroid gland. One of the probable thyroid operation complications is postoperative hypocalcemia. At present, there are no clear recommendations for preventing the development of postoperative hypocalcemia in patients undergoing surgery for DTG. In this regard, the issue of studying the methods of its prevention remains of current interest. The purpose of this study was to develop and introduce the tools for preventing postoperative hypocalcemia among patients operated for DTG into the clinical practice. Materials and methods. The paper presents the results of 27 examined patients with DTG that were operated from December 2016 to February 2018. At the time of surgery, all patients were in euthyroid state on the background of taking thiamazole at a dose of 5 mg/day to 30 mg/day. Results According to the results of determining the level of AT to the TTG receptors, the patients were divided into 2 groups: group I — patients with Graves’ disease (17 people), group II —patients with Plummer’s disease (10 people). In group I, thyroidectomy was performed in all patients, in group II thyroidectomy —in 7 patients and hemithyroidectomy —in 3 patients. The surgical interventions were performed according to the extrafascial technique using the device of high frequency welding of living tissues PATONMED. Due to the technique used, the visualization of the parathyroid glands has been greatly simplified and the probability of their accidental removal has significantly decreased. Patients of both groups received calcium preparations at a dose of 1 g/day for 10-14 days before surgery. 7 days before the operation, the dose was increased to 2 g/day. After finishing the surgical intervention, 60 ml (600 mg) of calcium glucanate was injected intravenously drip with 400 ml of physiological solution,and the next morning —40 ml (400 mg) per 400 ml of physiological solution. The next day after the surgety, patients started taking calcium preparations at a dose of 3 g/day with a gradual decrease in the dose. The rate of dose reduction was corrected on the basis of patient complaints, the presence or absence of clinical signs of hypocalcemia and the level of calcium ionized in the blood (if necessary). An obligatory stage of the study was to determine the level of calcium ionized in the blood at the preoperative stage and 2 days after surgery. The indices of calcium ionized at the preoperative stage were at the upper limit of the norm, and in some cases even higher. In the postoperative period, there was a clear tendency to decrease in the level of calcium in the blood despite the preventive measures. Laboratory data confirmed the decrease in calcium levels below the reference values in 5 cases. Clinical manifestations of hypocalcemia are found in 2 patients. Persistent hyperparathyroidism was not detected in the studied groups. Conclusions. The prescription of calcium preparations to patients with diffuse toxic goiter as a preventive measure at the pre- and postoperative stages significantly reduces the incidence of postoperative hypocalcemia.