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Content available remote Tetany as a Complication After Strumectomy
The study presented a case of a 54-year old woman who developed a fully symptomatic tetany syndrome with tachycardia and Chvostek's (++) sign during the initial 24 hours after subtotal strumectomy. Laboratory parameters demonstrated hypokalemia and hypocalcemia. After the intravenous injection of calcium chloride with simultaneous oral administration of alfacalcidiol, both the calcium and potassium levels returned to normal values.Postoperative tetany is observed in 0.2 to 5.8% of cases, according to literature data. Postoperative hypoparathyroidism may develop after total or subtotal thyroidectomy, as a result of the accidental excision of the parathyroid glands, their damage or vascularization. According to many authors postoperative hypoparathyroidism may result from the ligation of the lower thyroid artery, since these glands, both upper and lower, are supplied by blood in over 90% by the branches of these arteries. Other investigators maintain that tetany may also develop as a result of calcium metabolism disorders. Parathyroid ischemia may also result from pressure of the hematoma formed at the site of the removed thyroid lobes. The above-mentioned complication was probably influenced by a number of factors.
Content available remote One-Day Thyroid Surgery – Is it Safe?
was to evaluate the safety of one-day thyroid surgery based on the assessment of the incidence of early postoperative complications. Material and methods. The study comprised 726 patients who underwent total thyroidectomy during the period between January, 2012 and February, 2013. The study considered the three most common thyroidectomy complications. Results. In the group of 726 patients, recurrent laryngeal nerve paralysis was observed in 22 cases, accounting for 3.07% of all patients. Postoperative bleeding was observed in 12 cases (1.65%). In 8 cases, bleeding occurred during the first 8 hours after surgery, while in the remaining four cases- 9, 12, 18, and 26 hours after surgery. The study group was divided into three subgroups, in which the concentrations of calcium and parathyroid hormone, 6 hours and 20 hours after surgery, were determined. In the first group (223 patients), only the parathyroid hormone level was determined. The decreased PTH level was associated with the appearance of tetany symptoms in 15% of cases. Amongst patients in whom the parathyroid hormone level was normal, tetany symptoms were observed in 0.5% of cases. In the second group (256 patients), only the serum calcium level was determined. Amongst patients with normal serum calcium levels, 1% of cases presented with tetany symptoms. In patients where the serum calcium level was reduced, tetany symptoms appeared in 35% of cases. In the third group (247 patients), both serum calcium and parathyroid hormone levels were determined. In the group of patients with normal, both serum calcium and parathyroid hormone levels, tetany symptoms were not observed. Amongst patients with normal serum calcium levels and decreased PTH levels on the day of surgery, tetany symptoms were observed in 25% of cases, while during the first postoperative day-37% of cases. Conclusion. One-day thyroid surgery, due to the appearance of complications cannot be regarded as a completely safe procedure.
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