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. 1979 Oct;190(4):508–512. doi: 10.1097/00000658-197910000-00010

Delayed Hypocalcemia After Thyroidectomy for Graves' Disease is Prevented by Parathyroid Autotransplantation

Donald S Gann, Joseph F Paone
PMCID: PMC1344518  PMID: 582657

Abstract

Late hypocalcemia appears associated with thyroidectomy for Graves' disease more frequently than with thyroidectomy for other conditions. Of 62 total thyroidectomies done by a single surgeon, 28 were done for carcinoma, 18 for benign disease (primarily nontoxic nodules with a history of radiation therapy to the head and neck (RT)) and 16 for Graves' disease. Mean calcium concentrations measured two months or more after surgery were 9.38 ± 0.07 (SEM)mg/% for patients with cancer, 8.79 ± 0.31 mg/dl for patients with Graves' disease and 9.38 ± 0.08 mg/dl for patients with other benign diseases. No patient without Graves' disease developed late hypocalcemia. In contrast, six of 16 patients with Graves' developed significant late hypocalcemia requiring calcium therapy. The incidence of hypocalcemia after total thyroidectomy for Graves' disease was significantly greater than that seen in other conditions (p < 0.01). Since no parathyroids were removed in the patients with Graves' disease, and since branches of the inferior thyroid artery were invariably ligated distal to the parathyroids, we hypothesized that the late hypocalcemia might be associated with a peculiarity in scar formation in the presence of this autoimmune disease. Accordingly, parathyroid autotransplantation was performed synchronously as a prophylactic measure in nine subsequent patients undergoing total thyroidectomy for Graves' disease; no instance of late hypocalcemia has occurred in this group. The decreased incidence of late hypocalcemia is highly significant (p < 0.01). Although the precise etiology of late hypocalcemia after thyroidectomy for Graves' disease remains undetermined, this experience indicates that synchronous parathyroid autotransplantation is beneficial in preventing this complication.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BARTELS E. C. Hyperthyroidism; an evaluation of treatment with antithyroid drugs followed by subtotal thyroidectomy. Ann Intern Med. 1952 Dec;37(6):1123–1134. doi: 10.7326/0003-4819-37-6-1123. [DOI] [PubMed] [Google Scholar]
  2. BLANCHARD B. M. Focal hypocalcemic seizures 33 years after thyroidectomy. Arch Intern Med. 1962 Sep;110:382–385. doi: 10.1001/archinte.1962.03620210106018. [DOI] [PubMed] [Google Scholar]
  3. BUCKWALTER J. A., SOPER R. T., DAVIES J., MASON E. E. Postoperative hypoparathyroidism. Surg Gynecol Obstet. 1955 Dec;101(6):657–666. [PubMed] [Google Scholar]
  4. Barnes H. V., Gann D. S. Choosing thyroidectomy in hyperthyroidism. Surg Clin North Am. 1974 Apr;54(2):289–307. doi: 10.1016/s0039-6109(16)40280-x. [DOI] [PubMed] [Google Scholar]
  5. Beahrs O. H., Sakulsky S. B. Surgical thyroidectomy in the management of exophthalmic goiter. Arch Surg. 1968 Apr;96(4):512–516. doi: 10.1001/archsurg.1968.01330220028005. [DOI] [PubMed] [Google Scholar]
  6. Black B. M. Surgery for Graves' disease. Mayo Clin Proc. 1972 Dec;47(12):966–968. [PubMed] [Google Scholar]
  7. Block M. A., Miller J. M., Horn R. C. Minimizing hypoparathyroidism after extended thyroid operations. Surg Gynecol Obstet. 1966 Sep;123(3):501–506. [PubMed] [Google Scholar]
  8. DAVIS R. H., FOURMAN P., SMITH J. W. Prevalence of parathyroid insufficiency after thyroidectomy. Lancet. 1961 Dec 30;2(7218):1432–1435. doi: 10.1016/s0140-6736(61)91249-1. [DOI] [PubMed] [Google Scholar]
  9. FOURMAN P., DAVIS R. H., JONES K. H., MORGAN D. B., SMITH J. W. Parathyroid insufficiency after thyroidectomy. Review of 46 patients with a study of the effects of hypocalcaemia on the electro-encephalogram. Br J Surg. 1963 May;50:608–619. doi: 10.1002/bjs.18005022410. [DOI] [PubMed] [Google Scholar]
  10. JONES K. H., FOURMAN P. Prevalence of parathyroid insufficiency after thyroidectomy. Lancet. 1963 Jul 20;2(7299):121–124. doi: 10.1016/s0140-6736(63)92588-1. [DOI] [PubMed] [Google Scholar]
  11. Michie W., Duncan T., Hamer-Hodges D. W., Bewsher P. D., Stowers J. M., Pegg C. A., Hems G., Hedley A. J. Mechanism of hypocalcaemia after thyroidectomy for thyrotoxicosis. Lancet. 1971 Mar 13;1(7698):508–514. doi: 10.1016/s0140-6736(71)91122-6. [DOI] [PubMed] [Google Scholar]
  12. Michie W., Stowers J. M., Frazer S. C. Post-thyroidectomy hypocalcaemia. Lancet. 1977 May 14;1(8020):1051–1052. doi: 10.1016/s0140-6736(77)91277-6. [DOI] [PubMed] [Google Scholar]
  13. Nusynowitz M. L., Frame B., Kolb F. O. The spectrum of the hypoparathyroid states: A classification based on physiologic principles. Medicine (Baltimore) 1976 Mar;55(2):105–119. doi: 10.1097/00005792-197603000-00001. [DOI] [PubMed] [Google Scholar]
  14. PETCH C. P. Hypoparathyroidism presenting with convulsions 27 years after thyroidectomy. Lancet. 1963 Jul 20;2(7299):124–124. doi: 10.1016/s0140-6736(63)92589-3. [DOI] [PubMed] [Google Scholar]
  15. Perzik S. L., Catz B. The place of total thyroidectomy in the management of thyroid disease. Surgery. 1967 Sep;62(3):436–440. [PubMed] [Google Scholar]
  16. Roy A. D., Allan J., Harden R. M. A follow-up of thyrotoxic patients treated by partial thyroidectomy. Lancet. 1967 Sep 30;2(7518):684–688. doi: 10.1016/s0140-6736(67)90973-7. [DOI] [PubMed] [Google Scholar]
  17. Wells S. A., Jr, Gunnells J. C., Shelburne J. D., Schneider A. B., Sherwood L. M. Transplantation of the parathyroid glands in man: clinical indications and results. Surgery. 1975 Jul;78(1):34–44. [PubMed] [Google Scholar]
  18. Wilkin T. J., Isles T. E., Paterson C. R., Crooks J., Beck J. Post-thyroidectomy hypocalcaemia: A feature of the operation or the thyroid disorder? Lancet. 1977 Mar 19;1(8012):621–623. doi: 10.1016/s0140-6736(77)92057-8. [DOI] [PubMed] [Google Scholar]

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