Transient Symptomatic Hypocalcemia after Total Thyroidectomy: Two Case Reports
Abstract
Transient hypocalcemia after thyroidectomy happens despite watchful preservation of the parathyroid glands and their blood supplies during surgery. Thyroidectomy for Graves’ disease is accompanied by a higher risk of transient hypocalcemia than for benign thyroid disease, including goiter, and the reasons are still unclear. We report two patients with Graves’ disease and goiter with symptomatic hypocalcemia after total thyroidectomy.
We report a 64-year-old woman with multinodular goiter and a 41-year-old Iranian woman with a history of Graves’ disease who presented with transient symptomatic hypocalcemia after total thyroidectomy with intact parathyroid glands on surgery. They had a longer hospitalization time than usual surgeries due to hypocalcemia. However, they had normocalcemia at 1-year follow-up after discharge. Severe hypocalcemia after thyroidectomy can have some related complications and may be life-threatening. Calcium supplementation before surgery is a simple choice of treatment for the reduced probability of symptomatic hypocalcemia after Graves’ disease or benign thyroid disease in high-risk patients.
of hypocalcemia. World J Surg. 2008;32(7):1367-1373. https://doi.org/10.1007/s00268-008-9545-5
[2] Miratashi Yazdi SA, Nazar E. Genetic and Epigenetic Alterations in Parathyroid Neoplasms. Iran J Pathol. 2022;17(4):381-391. https://doi.org/10.30699/ijp.2022.551233.2865
[3] Oltmann SC, Brekke AV, Chen H, Sippel RS. Preventing postoperative hypocalcemia in patients with Graves disease:
a prospective study. Ann Surg Oncol. 2015;22(3):952-958. https://doi.org/10.1245/s10434-014-4077-8
[4] Bourrel C, Uzzan B, Tison P, Despreaux G, Frachet B, Modigliani E, et al. Transient hypocalcemia after thyroidectomy. Ann Otol Rhinol Laryngol. 1993;102(7):496-501. https://doi. org/10.1177/000348949310200702
[5] Daba KT, Weldemichael DK, Mulugeta GA. Bilateral hypocalcemic cataract after total thyroidectomy in a young
woman: a case report. BMC Ophthalmol. 2019;19(1):1-3. https://doi.org/10.1186/s12886-019-1224-9
[6] Baldassarre RL, Chang DC, Brumund KT, Bouvet M. Predictors of hypocalcemia after thyroidectomy: results from the
nationwide inpatient sample. ISRN Surg. 2012;2012:838614. https://doi.org/10.5402/2012/838614
[7] Jessie W, Harrison B, Wu J. Hypocalcemia after thyroidectomy: the need for improved definitions. World J
Endocr Surg. 2010;2(1):17-20. https://doi.org/10.5005/jpjournals-10002-1045
[8] Păduraru DN, Nica A, Carsote M, Valea A, Ghemigian A, Nistor C, et al. Post-thyroidectomy hypocalcemia - risk factors and management. Chirurgia (Bucur). 2019;114(5):564-570. https://doi.org/10.21614/chirurgia.114.5.564
[9] Wilson RB, Erskine C, Crowe PJ. Hypomagnesemia and hypocalcemia after thyroidectomy: a prospective study.
World J Surg. 2000;24(6):722-726. https://doi.org/10.1007/s002689910116
[10] Miyashita K, Uchida T, Mori M, Taniyama M, Kajita K, Suzuki S, et al. A Case of Hypocalcemia with Severe Vitamin D
Deficiency following Treatment for Graves’ Disease with Methimazole. Case Rep Endocrinol. 2013;2013:356819.
https://doi.org/10.1155/2013/356819
[11] Pesce CE, Shiue Z, Tsai HL, Umbricht CB, Tufano RP, Dackiw AP, et al. Postoperative hypocalcemia after thyroidectomy for Graves’ disease. Thyroid. 2010;20(11):1279-1283. https://doi.org/10.1089/thy.2010.0047
[12] Hallgrimsson P, Nordenström E, Bergenfelz A, Almquist M. Risk factors for medically treated hypocalcemia after surgery for Graves’ disease: a Swedish multicenter study of 1,157 patients. World J Surg. 2012;36(8):1933-1942. https://doi.org/10.1007/s00268-012-1574-4
[13] Noordzij JP, Lee SL, Bernet VJ, Payne RJ, Cohen SM, McLeod IK, et al. Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies. J Am Coll Surg. 2007;205(6):748-754. https://doi.org/10.1016/j.jamcollsurg.2007.06.286
[14] Abboud B, Sargi Z, Akkam M, Sleilaty F. Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg.
2002;195(4):456-461. https://doi.org/10.1016/S1072-7515(02)01310-8
| Files | ||
| Issue | Vol 11 No 2 (2026): March-April | |
| Section | Case Report(s) | |
| Keywords | ||
| Hypocalcemia Thyroidectomy Graves’ disease Multinodular goiter | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
