A Cohort Study Assessing the Association Between Body Composition Parameters and Symptomatic Hypocalcemia After Total Thyroidectomy

Celik S. U., KONCA C., GENÇ V.

AMERICAN SURGEON, vol.87, no.8, pp.1305-1312, 2021 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 87 Issue: 8
  • Publication Date: 2021
  • Doi Number: 10.1177/0003134820979578
  • Journal Name: AMERICAN SURGEON
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CAB Abstracts, CINAHL, EMBASE, MEDLINE
  • Page Numbers: pp.1305-1312
  • Keywords: body composition, hypocalcemia, hypoparathyroidism, thyroid, total thyroidectomy, PARATHYROID-HORMONE, PREDICTORS, DISCHARGE, SAFE, MASS, PTH
  • Ankara University Affiliated: Yes


Background Postoperative hypocalcemia is one of the major concerns following thyroidectomy and the most frequent cause of prolonged hospital stay. The aim of this study was to evaluate the relationship between body composition parameters and symptomatic hypocalcemia following total thyroidectomy. In addition, the effects of disease- and patient-related factors on hypocalcemia were investigated. Methods A total of 144 patients were prospectively included between March 2014 and September 2017. Patients were divided into 2 groups according to the presence or absence of clinical symptoms of hypocalcemia. Subsequently, the relationship between body composition parameters and hypocalcemia was evaluated. Results Postoperative hypocalcemia-related symptoms occurred in 28 patients (19.4%). Permanent hypocalcemia was not encountered in any patient. Patients with hypocalcemic symptoms were more likely to have nodules >= 40 mm (39.3% vs. 17.2%, P = .011), retrosternal goiters (25.0% vs. 7.8%, P = .017), central lymph node dissection (LND) (32.1% vs. 11.2%, P = .015), and parathyroid autotransplantation (28.6% vs. 3.4%, P < .001) than those without symptoms. However, no differences were observed in the body composition parameters between symptomatic and asymptomatic patients. On multivariate analysis, lower preoperative intact parathyroid hormone (iPTH) levels (odds ratios (ORs) .96, 95% confidence intervals (CIs) .93-.99), the presence of retrosternal goiters (OR 10.26, 95% CI 2.23-47.14), central LND (OR 16.05, 95% CI 3.90-66.07), and parathyroid autotransplantation (OR 36.22, 95% CI 6.76-194.13) predicted hypocalcemia. Discussion This study demonstrates that patients with lower preoperative iPTH levels, retrosternal goiters, central LND, and parathyroid autotransplantation are at an increased risk of developing clinical symptoms of hypocalcemia. Body composition parameters have no effect on the incidence of hypocalcemia after total thyroidectomy.