title: Hypocalcaemia following total thyroidectomy: An analysis of 806 patients.
abstract: BACKGROUND
  Permanent hypocalcaemia following thyroidectomy causes considerable morbidity. This prospective observational study aims to define the factors likely to predict hypocalcaemia following total thyroidectomy.
  
  
  METHODS
  Patients who were subjected to total thyroidectomy during January 2005 to December 2009 were followed up for a minimum period of 1 year. Efficacy of an intraoperative parathyroid hormone assay to predict hypocalcaemia was validated.
  
  
  RESULTS
  Overall incidence of hypocalcaemia was 23.6% (n = 190) and that of permanent hypocalcaemia was 1.61% (n = 13). Onset was delayed up to 3(rd) postoperative day in 13 patients. Hypocalcaemia was significantly associated with thyroidectomy for Grave's Disease (P = 0.001), Hashimoto's thyroiditis (P = 0.003), and with incidental parathyroidectomy (P = 0.006). The intraoperative assay of parathyroid hormone showed low sensitivity (0.5) and satisfactory specificity (0.9) in predicting hypocalcemia.
  
  
  CONCLUSIONS
  Hypocalcemia could manifest late in the immediate postoperative period and this may explain latent hypocalcemia. High incidence of hypocalcaemia noted in Grave's Disease could be due to the autoimmunity since same feature was noted associated with Hashimoto's thyroiditis and the incidence of hypocalcaemia was not high in the subgroup with toxic nodular goiter. The incidence of hypocalcemia was not affected by age or sex.
authors.affiliation: Department of General Surgery, Amrita Institute of Medical Sciences, Elamakkara, Ernakulam, Kerala State, India.
authors.forename: C Gopalakrishnan
authors.initials: CG
authors.lastname: Nair
authors.forename: Misha J C
authors.initials: MJ
authors.lastname: Babu
authors.forename: Riju
authors.initials: R
authors.lastname: Menon
authors.forename: Pradeep
authors.initials: P
authors.lastname: Jacob
keywords: Grave's disease; hyperthyroidism; hypocalcemia; total thyroidectomy