Prediction of hypocalcemia after total thyroidectomy

Hypocalcemia due to a dysfunction of the parathyroid glands is a frequent complication after total thyroidectomy. The incidence has been reported at 8% for transient hypoparathyroidism and at 1.5% for permanent hypoparathyroidism. Devascularization or accidental removal of the parathyroid gland is the most common reason for postoperative hypocalcemia. Intraoperative measurement of parathyroid hormone levels is an accurate method of predicting postoperative parathyroid dysfunction and replaces repetitive calcium measurements. Patients at risk for postoperative hypocalcemia can be detected early and can be treated adequately, which reduces the duration of hospital stays. Postoperative parathyroid hormone levels below normal or a decrease of >75% from the initial level is significantly associated with symptomatic postoperative hypocalcemia. These patients have to be treated prophylactically.