FREQUENCY OF HYPOCALCEMIA IN MULTINODULAR GOITRE PATIENTS UNDERGOING TOTAL THYROIDECTOMY

Abstract

Background: Postoperative hypocalcemia is a clinically important complication of total thyroidectomy that may prolong biochemical monitoring, delay discharge, and necessitate calcium and vitamin D therapy. Objective: To determine the frequency of early postoperative hypocalcemia and evaluate associated demographic, clinical, histopathological, and biochemical factors among patients with multinodular goitre undergoing total thyroidectomy. Methods: This prospective observational study included 125 patients aged 18–60 years undergoing total thyroidectomy at ENT Unit 1, Jinnah Hospital, Lahore for the duration of three months, from March 02, 2026 to June 02, 2026. Pakistan. Demographic, clinical, operative, histopathological, serum calcium, parathyroid hormone (PTH), and hospital-stay data were recorded. Early postoperative hypocalcemia was defined as serum calcium <8.5 mg/dL at 24 hours. Group comparisons, crude odds ratios, and an exploratory adjusted logistic regression analysis were performed. Results: Early postoperative hypocalcemia occurred in 19 of 125 patients (15.2%; 95% CI, 10.0%–22.5%). Patients with hypocalcemia were younger than normocalcemic patients (37.74 ± 8.93 vs 42.81 ± 9.38 years; p=0.031). Thyroiditis was associated with higher crude odds of hypocalcemia (OR=3.62, 95% CI 1.16–11.29; p=0.032). The hypocalcemia group had lower serum calcium at 24 hours and one week, lower postoperative PTH, and longer hospital stay (all p<0.001). Postoperative PTH remained inversely associated with hypocalcemia in exploratory adjusted analysis (adjusted OR=0.587, 95% CI 0.433–0.795; p=0.001). Conclusion: Early postoperative biochemical hypocalcemia occurred in approximately one in six patients. Lower postoperative PTH showed a strong inverse association with hypocalcemia, while thyroiditis was associated with increased crude odds. These findings support focused early biochemical surveillance after total thyroidectomy.