Postoperative transient hypoparathyroidism in graves' disease

ABSTRACT

Postoperative tetany occurs in patients with secondary hyperparathyroidism caused by a deficiency in calcium and Vitamin D concomitant with transient hypoparathyroidism induced by surgery. In this study, we try to predict the risk factors for this observation by referring to serum 25-hydroxyvitamin D and alkaline phosphatase. The serum level of intact parathyroid hormone, calcium, other electrolytes, and 25-hydroxyvitamin D were measured preoperatively in 59 female patients with Graves' disease who underwent Subtotal thyroidectomy. A systematic accurate identification and preservation of parathyroid glands were always performed. Of the 59 female patients, 5 [8.4%] developed tetany. From analysis of different possible risk factors, the results showed that two were statistically significant serum 25-hydroxyvitamin D [25 [OH] D] and alkaline Phosphatase [ALP] levels. The incidence of tetany according to the serum levels of 25 [OH] D and ALP was 20% [3/15] in patients with 25 [OH] D l55U/L, 9.09% [1/11] in those with 25 [OH] D 10 ngm/ml and ALP> 155u/L, and 0% [0/17] in those with 25 [OH] D> 10 ngm/ml and ALP >/= 155 u/L. Patients with Graves disease who have vitamin D deficiency and high serum alkaline phophatase levels is the highest risk group for postoperative tetany, so, serum 25 [OH] D and ALP should be monitired in patients with Graves' disease and preventive prescription of vitamin D and Calcium is recommended