FACTORS OF DEVELOPMENT OF POSTOPERATIVE HYPOCALCIEMIA DURING SINGLE-STOP OPERATIONS ON THE THYROID AND PARATHYROID GLANDS

Abstract Factors of development of postoperative hypocalciemia during single-stop operations on the thyroid and parathyroid glands/ One of the most common complications during simultaneous thyroid and parathyroid surgery is postoperative hypocalcemia. The aim of the study was to determine the risks for predicting the development of postoperative hypocalcemia during simultaneous thyroid and parathyroid surgery. 506 medical histories of patients operated on in the period from 2017 to 2024 were retrospectively studied. 62 patients were excluded (previously operated on the thyroid gland, had varying degrees of renal failure). Therefore, 444 patients were included in the study. Among them, 140 patients with multinodular goiter, 130 patients with thyrotoxicosis, 174 patients with thyroid cancer (according to the results of pathohistological examination). 366 thyroidectomies and 78 hemithyroidectomies were performed. Hypercalcemia before surgery was detected in 55 (12.4%). With further careful examination, the presence of PHPT was established in 22 patients (5.0%). In 33 cases, an increase in the level of Ca++ was recorded against the background of thyrotoxicosis. Depending on the clinical manifestations of hypocalcemia in the postoperative period, patients were divided into 3 groups: Asymptomatic: clinically practically not manifested. It occurs, as a rule, when performing hemi- or thyroidectomy and PHPT with a moderately pronounced increase in parathyroid hormone and calcium in the blood. It is about 20%. Asymptomatic: there are clinical signs of hypocalcemia. It occurs, as a rule, after thyroidectomy with central neck dissection, the presence of thyrotoxicosis before surgery or when performing contralateral hemithyroidectomy and removal of pathologically altered parathyroid gland. It is about 70%. Severe form: clinical signs are pronounced. It occurs, as a rule, after removal of a large adenoma or parathyroid cancer, high levels of parathyroid hormone and Ca++ at the preoperative stage and simultaneous total thyroidectomy with central neck dissection. It is about 10%. Conclusion: the development of postoperative hypocalcemia is associated not only with the rising level of parathyroid hormone and calcium in the blood, but also with the volume of surgical intervention on the thyroid gland. Prognostically, the most unfavorable is the combination of PHPT and the need for total thyroidectomy (especially with central dissection or with diffuse toxic goiter), the combination of removal of parathyroid adenoma with contralateral hemithyroidectomy or thyroidectomy is less risky. The lowest risk of developing hypocalcemia is in patients with moderate PHPT and ipsilateral removal of one lobe of the thyroid gland.