title: The Role of Magnesium in Post-thyroidectomy Hypocalcemia.
abstract: BACKGROUND
  The purpose of this study was to determine the prevalence of hypomagnesemia in patients undergoing thyroidectomy and evaluate the relationship of hypomagnesemia with transient and severe hypocalcemia.
  
  
  METHODS
  This was a prospective observational study of 50 patients undergoing thyroidectomy. Blood samples were collected pre- and postoperatively for calcium, albumin, magnesium, phosphorous and parathormone (PTH). Signs, symptoms of hypocalcemia and volume of intravenous fluids used perioperatively were documented. The statistical analysis was performed using STATA I/C 10.1.
  
  
  RESULTS
  Preoperatively, twelve patients (24 %) had hypomagnesemia and one (2 %) hypocalcemia. On the first postoperative day, hypomagnesemia was seen in 70 % and hypocalcemia in 30 %. A similar trend was observed in the fall and rise of postoperative calcium and magnesium values (p = 0.41). Severe hypocalcemia was present in three patients (6 %). All three patients had a very low postoperative PTH (<2 pg/ml). Among them, two patients (66 %) had hypomagnesemia and their hypocalcemia responded to intravenous magnesium correction. Significant risk factors for postoperative hypocalcemia include a higher volume of fluid used perioperatively and low postoperative PTH (<8 pg/ml) (p = 0.01 and 0.03, respectively).
  
  
  CONCLUSIONS
  Preoperative hypomagnesemia (24 %) was prevalent in this cohort of patients. Postoperative hypomagnesemia is a common event (70 %) following total thyroidectomy, and magnesium levels tend to mimic the calcium levels postoperatively. The cause of hypocalcemia post-thyroidectomy in this study is mainly a factor of parathyroid function and fluid status. Severe hypocalcemia is a rare event, and hypomagnesemia is associated in the majority of these patients. The role of magnesium correction to alleviate severe hypocalcemia needs to be further studied.
authors.affiliation: Department of Endocrine Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India. anish@cmcvellore.ac.in.
authors.forename: Anish Jacob
authors.initials: AJ
authors.lastname: Cherian
authors.affiliation: Department of Biostatistics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
authors.forename: Mahasampath
authors.initials: M
authors.lastname: Gowri
authors.affiliation: Department of Endocrine Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
authors.forename: Pooja
authors.initials: P
authors.lastname: Ramakant
authors.affiliation: Department of Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Paul
authors.affiliation: Department of Endocrine Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
authors.forename: Deepak Thomas
authors.initials: DT
authors.lastname: Abraham
authors.affiliation: Department of Endocrine Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
authors.forename: Mazhuvanchary Jacob
authors.initials: MJ
authors.lastname: Paul
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood*; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D008274:Magnesium / Q000097:blood* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands; D010281:Parathyroid Hormone / Q000097:blood*; D010758:Phosphorus / Q000097:blood; D011183:Postoperative Complications / Q000097:blood*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index; D013965:Thyroidectomy; D014883:Water-Electrolyte Imbalance / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone; D012709:Serum Albumin; D010758:Phosphorus; D008274:Magnesium; D002118:Calcium