Postoperative Hypokalzämie nach Thyreoidektomie
Eine zehnjährige Kohortenstudie zu klinischen und chirurgischen Prädiktoren für Hypokalzämie nach Thyreoidektomie
This retrospective cohort study investigates predictors of postoperative hypocalcemia following thyroidectomy procedures at Minia University Hospital over a 10-year period (2014-2024). Postthyroidectomy hypocalcemia is one of the most common complications of thyroid surgery, affecting 20-50% of patients. The study aims to identify demographic, clinical, laboratory, and surgical factors associated with the development of both transient and permanent hypocalcemia. Results will inform risk stratification, patient counseling, and perioperative management strategies.
Studienübersicht
Status
Status
Bedingungen
Bedingungen
Detaillierte Beschreibung
Hypocalcemia is a frequent complication following thyroidectomy, resulting from inadvertent parathyroid gland injury, removal, or devascularization. While most cases resolve within 6 months (transient hypocalcemia),permanent hypocalcemia occurs in 1-3% of patients and requires lifelong calcium and vitamin D supplementation, significantly impacting quality of life.
This single-center retrospective study will systematically review medical records of all patients who underwent thyroidectomy (total, subtotal, or completion) at Minia University Hospital between January 1, 2014, andDecember 31, 2024. The primary objective is to identify independent predictors of postoperative hypocalcemia using multiple logistic regression analysis.
Data extraction will include:
Demographics: age, gender, BMI Clinical factors: indication for surgery, thyroid disease type, presence of Graves' disease, substernal extension Preoperative laboratory values: calcium, vitamin D, PTH, thyroid function tests Surgical details: extent of thyroidectomy, central/lateral lymph node dissection, surgeon experience,operative time, parathyroid gland identification and autotransplantation Postoperative data: calcium levels (24h, 48h, 1 week, 6 weeks, 3 months, 6 months), PTH levels,supplementation requirements Pathology: thyroid weight, presence of parathyroid tissue in specimen, thyroiditis, malignancy The study will employ robust statistical methods including univariate analysis to screen potential predictors and multiple logistic regression to identify independent risk factors. A clinical risk prediction score will be developed and internally validated using split-sample methodology. Subgroup analyses will examine differences between transient and permanent hypocalcemia and stratify results by extent of surgery and surgeon experience.
Target sample size of 500-600 patients was calculated using G*Power to ensure adequate statistical power(>80%) .
Findings will contribute to evidence-based perioperative protocols, improved patient selection for outpatient thyroidectomy, tailored monitoring strategies, and informed decision-making regarding prophylactic calcium supplementation.
Studientyp
Studientyp
Einschreibung (Geschätzt)
Einschreibung
Kontakte und Standorte
Studienkontakt
Studienkontakt
- Name: Saleh K Saleh, MD
- Telefonnummer: +2 01201765401
- E-Mail: salehkhairy@mu.edu.eg
Studienorte
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Minya Governorate
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Minya, Minya Governorate, Ägypten, 61519
- Rekrutierung
- Minia University Hospital
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Kontakt:
- Saleh K Saleh, MD
- Telefonnummer: +2 01201765401
- E-Mail: salehkhairy@mu.edu.eg
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Unterermittler:
- Rabeh K Saleh, MD
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Kontakt:
- E-Mail: salehkhairy@mu.edu.eg
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Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
Akzeptiert gesunde Freiwillige
Studienberechtigte Geschlechter
Probenahmeverfahren
Studienpopulation
This retrospective cohort study will include adult patients (aged 18 years and older) who underwent a thyroidectomy procedure at Minia University Hospital, a tertiary care centre in Egypt, between January 1, 2014, and December 31, 2024. The target population consists of approximately 600 consecutive patients who meet the eligibility criteria. This includes patients with available medical records containing complete surgical and postoperative data, documented postoperative serum calcium levels, and a minimum of 6 months of follow-up or a documented outcome status. Patients will be excluded if they have preoperative hypocalcemia, pre-existing parathyroid disorders, chronic kidney disease (Stage 3 or higher), or other conditions that significantly affect calcium metabolism. The study population represents a consecutive sample of all patients meeting these criteria over the 10-year study period at this single academic center.
Beschreibung
Inclusion Criteria:
- Adult patients aged 18 years or older at time of surgery
- Underwent thyroidectomy at Minia University Hospital
- Availability of medical records with complete surgical and postoperative data
- Documented serum calcium levels measured postoperatively
- Minimum follow-up of 6 months postoperatively or documented outcome status
Exclusion Criteria:
- Age less than 18 years at time of surgery
- Preoperative hypocalcemia (serum calcium <8.0 mg/dL or ionized calcium <1.0 mmol/L)
- Pre-existing parathyroid disorders (primary hyperparathyroidism, hypoparathyroidism, secondary or tertiary hyperparathyroidism)
- Chronic kidney disease Stage 3 or higher (estimated glomerular filtration rate <60 mL/min/1.73m²)
- Malabsorption syndromes affecting calcium metabolism (celiac disease, inflammatory bowel disease,short bowel syndrome)
- Concurrent planned parathyroidectomy
- History of neck irradiation
- Chronic use of medications significantly affecting calcium metabolism (bisphosphonates, denosumab,cinacalcet, chronic corticosteroids)
- Incomplete medical records lacking essential data including surgical details, postoperative calcium levels,or follow-up data
- Patients lost to follow-up before 6-month endpoint without documented outcome status
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Beobachtungsmodelle: COHORT
- Zeitperspektiven: RETROSPECTIVE
Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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Incidence of Postoperative Hypocalcemia
Zeitfenster: Within 6 months post-surgery
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Development of hypocalcemia defined as: Serum total calcium <8.0 mg/dL (2.0 mmol/L) OR Ionized calcium <1.0 mmol/L OR Symptomatic hypocalcemia (perioral numbness, paresthesias, carpopedal spasm, positive Chvostek's orTrousseau's sign) requiring calcium supplementation Measured at: 24 hours, 48 hours, 1 week, 6 weeks, 3 months, and 6 months postoperatively |
Within 6 months post-surgery
|
Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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Incidence of Transient Hypocalcemia
Zeitfenster: Up to 6 months post-surgery
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Hypocalcemia that resolves within 6 months of surgery without need for continued calcium and/or vitamin D supplementation beyond 6-month follow-up |
Up to 6 months post-surgery
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Incidence of Permanent Hypocalcemia
Zeitfenster: 6 months post-surgery
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Hypocalcemia requiring ongoing calcium and/or vitamin D supplementation persisting beyond 6months postoperatively, indicating permanent hypoparathyroidism |
6 months post-surgery
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Incidence of Symptomatic Hypocalcemia
Zeitfenster: Within 2 weeks post-surgery
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Clinical manifestations of hypocalcemia including: Neuromuscular irritability (perioral tingling, paresthesias) Tetany or carpopedal spasm Positive Chvostek's sign (facial nerve twitching) Positive Trousseau's sign (carpal spasm with blood pressure cuff inflation) Seizures (rare) Cardiac manifestations: prolonged QT interval, arrhythmias (rare) |
Within 2 weeks post-surgery
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Hospital Length of Stay
Zeitfenster: From surgery to discharge, typically 2-5 days
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Duration of hospitalization in days following thyroidectomy, measured from date of surgery to date of hospital discharge |
From surgery to discharge, typically 2-5 days
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Calcium and Vitamin D Supplementation Requirement
Zeitfenster: Up to 6 months post-surgery
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Need for oral calcium supplementation (yes/no and total daily dose in mg) Need for vitamin D supplementation (yes/no and total daily dose in IU) Duration of supplementation (days/weeks) Need for intravenous calcium administration (yes/no) |
Up to 6 months post-surgery
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Emergency Department Visits for Hypocalcemia
Zeitfenster: Within 30 days post-discharge
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Unplanned emergency department visits related to symptoms of hypocalcemia or complications of calcium/vitamin D therapy |
Within 30 days post-discharge
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Hospital Readmission Related to Hypocalcemia
Zeitfenster: Within 30 days post-discharge
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Unplanned hospital readmission related to symptomatic hypocalcemia or its complications |
Within 30 days post-discharge
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Postoperative Parathyroid Hormone (PTH) Level
Zeitfenster: 24 hours post-surgery
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Serum intact parathyroid hormone level measured within 24 hours postoperatively (pg/mL), used as predictor of sustained hypocalcemia |
24 hours post-surgery
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Nadir Calcium Level
Zeitfenster: Within 7 days post-surgery
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Lowest serum calcium level (total or ionized) recorded during initial hospitalization or within first week postoperatively |
Within 7 days post-surgery
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Time to Calcium Normalization
Zeitfenster: Up to 6 months post-surgery
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Duration in days from surgery to sustained normalization of serum calcium levels without supplementation (for those who develop hypocalcemia) |
Up to 6 months post-surgery
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Mitarbeiter und Ermittler
Sponsor
Sponsor
Ermittler
Ermittler
- Hauptermittler: Saleh K Saleh, MD, Minia University
Publikationen und hilfreiche Links
Allgemeine Veröffentlichungen
- Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg. 2014 Mar;101(4):307-20. doi: 10.1002/bjs.9384. Epub 2014 Jan 9.
- Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery. 2003 Feb;133(2):180-5. doi: 10.1067/msy.2003.61.
- Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A. Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg. 2015 Mar;102(4):359-67. doi: 10.1002/bjs.9676. Epub 2015 Jan 20.
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Tatsächlich)
Studienbeginn
Primärer Abschluss (Geschätzt)
Primärer Abschluss
Studienabschluss (Geschätzt)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Schlüsselwörter
Zusätzliche relevante MeSH-Bedingungen
- Erkrankungen des endokrinen Systems
- Pathologische Prozesse
- Neubildungen nach Standort
- Neubildungen
- Stoffwechselerkrankungen
- Neoplasmen der endokrinen Drüse
- Kopf-Hals-Neubildungen
- Wasser-Elektrolyt-Ungleichgewicht
- Nebenschilddrüsenerkrankungen
- Schilddrüsenerkrankungen
- Störungen des Kalziumstoffwechsels
- Pathologische Zustände, Anzeichen und Symptome
- Ernährungs- und Stoffwechselerkrankungen
- Schilddrüsenknoten
- Hypoparathyreoidismus
- Schilddrüsenneoplasmen
- Postoperative Komplikationen
- Hypokalzämie
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- 1878/02/2026
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