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9 - Can a multifactorial scoring system be constituted for predicting the hypocalcemia following total thyroidectomy?
Evren Besler, Nurcihan Aygün, Bülent Çitgez, Hamdi Özşahin, Murat Ferhat Ferhatoğlu, Mehmet Mihmanlı, Sıtkı Gürkan Yetkin, Mehmet Uludağ
Objective: Hypocalcemia following total thyroidectomy is the most common complication of this operation. This complication is related with severe symptoms of patients and delay of hospital stay. Several factors had been investigated to predict the hypocalcemia following total thyroidectomy in recent studies. In this study it is aimed to constitute a scoring system with the combination of more than one factor for predicting temporary hypocalcemia.
Material and Method: The retrospective data of the patients of whom underwent total thyroidectomy between the years of 2012-2013 were evaluated. All the parameters related with hypocalcemia are rated as one point. Hypocalcemia is defined as total plasma calcium (Ca) level below 8 mg/dl. Temporary hypocalcemia is defined as recovery of hypoparathyroidizm in 6 months following total thyroidectomy. Multinomial logistic regression analysis, Chi-Squared test, Fishers exact test and Mann-Whitney U test were used for statistics.
Results: Temporary hypocalcemia occurred in 22 of 155 (14.2%) patients. The existence of parathyroid gland in surgical specimen (p<0.01), the low levels of early postoperative plasma calcium levels (p=0.0001), postoperative plasma magnesium levels (p=0.0001), postoperative plasma parathormone levels (p=0.0001) were statisticallly significant in paired comparison. The score of 3,4,5 were statisticallly significant for predicting the occurance of hypocalcemia (p=0.001). With the score of ?3/?4/?5; sensitivity was 100%/77.27%/59.09%, specifitiy was 46.62%/77.44%/91.73%, negative predictive value was 0.00%/4.63%/6.87% positive predictive value 23.66%/36.17%/54.15% and diagnostic value was 54.19%/77.42%/87.10% respectively.
Conclusion: Postoperative hypocalcemia is multifactorial. Although the existence of 4,5,6, score is free indicator of predicting hypocalcemia, it would not be suggested as an exact scoring system because of the low negative and positive predicitive values. Patients with low values of postoperative early plasma calcium, magnesium and parathormone levels should be followed up carefully for hypocalcemia
Keywords: Hypocalcemia, predicting hypocalcemia, total thyroidectomy, scoring system
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