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Pre-operative serum alkaline phosphatase as a predictive indicator of post-operative hypocalcaemia in patients undergoing total thyroidectomy

Published online by Cambridge University Press:  29 September 2015

M S Miah ,
S Mahendran ,
C Mak ,
G Leese  and
D Smith
M S Miah*
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Ninewells Hospital and University of Dundee Medical School, Scotland, UK
S Mahendran
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Ninewells Hospital and University of Dundee Medical School, Scotland, UK
C Mak
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Ninewells Hospital and University of Dundee Medical School, Scotland, UK
G Leese
Affiliation:
Department of Endocrinology, Ninewells Hospital and University of Dundee Medical School, Scotland, UK
D Smith
Affiliation:
Department of General Surgery, Ninewells Hospital and University of Dundee Medical School, Scotland, UK
*
Address for correspondence: Mr M S Miah, Department of Otorhinolaryngology – Head and Neck Surgery, Ninewells Hospital and University of Dundee Medical School, Dundee DD1 9SY, Scotland, UK Fax: +44 1382 632816 E-mail: [email protected]
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Abstract

Objective:

This study aimed to evaluate whether a pre-operative elevated serum alkaline phosphatase level is a potential predictor of post-operative hypocalcaemia after total thyroidectomy.

Methods:

Data was retrospectively collected from the case notes of patients who had undergone total thyroidectomy. Patients were divided into Graves’ disease and non-Graves’ groups. Pre-operative and post-operative biochemical markers, including serum calcium, alkaline phosphatase and parathyroid hormone levels, were reviewed.

Results:

A total of 225 patients met the inclusion criteria. Graves’ disease was the most common indication (n = 134; 59.5 per cent) for thyroidectomy. Post-operative hypocalcaemia developed in 48 patients (21.3 per cent) and raised pre-operative serum alkaline phosphatase was noted in 94 patients (41.8 per cent). Raised pre-operative serum alkaline phosphatase was significantly associated with post-operative hypocalcaemia, particularly in Graves’ disease patients (p< 0.05).

Conclusion:

Pre-operative serum alkaline phosphatase measurements help to predict post-thyroidectomy hypocalcaemia, especially in patients who do not develop hypoparathyroidism. Ascertaining the pre-operative serum alkaline phosphatase level in patients undergoing total thyroidectomy may help surgeons to identify at-risk patients.

Keywords

HypocalcemiaAlkaline PhosphataseThyroidectomyGraves Disease
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 11 , November 2015 , pp. 1128 - 1132
Copyright
Copyright © JLO (1984) Limited 2015 

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Footnotes

Presented as an oral presentation at the Scottish Otorhinolaryngological Society meeting, 12 May 2012, Dunblane, Scotland, UK, and as a poster at the 14th British Academic Conference in Otolaryngology, 4–6 July 2012, Glasgow, Scotland, UK

References

1Pfleiderer, AG, Ahmadi, N, Draper, MR, Vrotsou, K, Smith, WK. The timing of calcium measurements in helping to predict temporary and permanent hypocalcaemia in patients having completion and total thyroidectomies. Ann R Coll Surg Engl 2009;91:140–6CrossRefGoogle ScholarPubMed
2Sokouti, M, Montazeri, V, Golzari, S. The incidence of transient and permanent hypocalcaemia after total thyroidectomy for thyroid cancer. Int J Endocrinol Metab 2010;1:7–12Google Scholar
3Kim, JH, Chung, MK, Son, YI. Reliable early prediction for different types of post-thyroidectomy hypocalcemia. Clin Exp Otorhinolaryngol 2011;4:95–100CrossRefGoogle ScholarPubMed
4The British Association of Endocrine & Thyroid Surgeons, 2012. Fourth Annual Audit Report. In: www.baets.org.uk/wp-content/uploads/2013/05/4th-National-Audit.pdf [17 November 2014].Google Scholar
5Allain, TJ, McGregor, AM. Thyroid hormones and bone. J Endocrinol 1993;139:9–18CrossRefGoogle ScholarPubMed
6Britto, J, Fenton, A, Holloway, W, Nicholson, GC. Osteoblasts mediate thyroid hormone stimulation of osteoclastic bone resorption. Endocrinology 1994;134:169–76CrossRefGoogle ScholarPubMed
7Siddiqi, A, Burrin, J, Noonan, K, James, I, Wood, DF, Price, CP et al. A longitudinal study of markers of bone turnover in Graves’ disease and their value in predicting bone mineral density. J Clin Endocrinol Metab 1997;82:753–9Google ScholarPubMed
8Kirkby-Bott, J, Markogiannakis, H, Skandarajah, A, Cowan, M, Fleming, B, Palazzo, F. Preoperative vitamin D deficiency predicts postoperative hypocalcemia after total thyroidectomy. World J Surg 2011;35:324–30CrossRefGoogle ScholarPubMed
9Sousa, AA, Salles, JMP, Soares, JMA, Moraes, GM, Carvalho, JR, Savassi-Rocha, PR. Evolution of blood magnesium and phosphorus ion levels following thyroidectomy and correlation with total calcium values. Sao Paulo Med J 2010;128:268–71CrossRefGoogle ScholarPubMed
10Erbil, Y, Ozbey, NC, Sari, S, Unalp, HR, Agcaoglu, O, Ersöz, F et al. Determinants of postoperative hypocalcemia in vitamin D-deficient Graves’ patients after total thyroidectomy. Am J Surg 2011;201:685–91CrossRefGoogle ScholarPubMed
11Demeester-Mirkine, N, Hooghe, L, Van Geertruyden, J, De Maertelaer, V. Hypocalcemia after thyroidectomy. Arch Surg 1992;127:854–8CrossRefGoogle ScholarPubMed
12Wilkin, TJ, Isles, TE, Paterson, CR, Crooks, J, Beck, J. Post-thyroidectomy hypocalcaemia: A feature of the operation or the thyroid disorder? Lancet 1977;1:621–3CrossRefGoogle ScholarPubMed
13Yu, N, Leese, GP, Smith, D, Donnan, PT. The natural history of treated and untreated primary hyperparathyroidism: the Parathyroid Epidemiology and Audit Research Study. Q J Med 2011;104:513–21CrossRefGoogle ScholarPubMed
14Michie, W, Duncan, T, Hamer-Hodges, DW, Bewsher, PD, Stowers, JM, Pegg, CA et al. Mechanism of hypocalcaemia after thyroidectomy for thyrotoxicosis. Lancet 1971;1:508–14CrossRefGoogle ScholarPubMed
15Abu, EO, Bord, S, Horner, A, Chatterjee, VK, Compston, JE. The expression of thyroid hormone receptors in human bone. Bone 1997;21:137–42CrossRefGoogle ScholarPubMed
16Bhattacharyya, A, New, JP. Hungry Bone Syndrome – Revisited. J R Coll Physicians Edinb 2002;32:83–6Google Scholar
17Ali, S, Yu, C, Palmer, FL, Ganly, I, Shaha, A, Shah, JP et al. Nomogram to aid selection of patients for short-stay thyroidectomy based on risk of postoperative hypocalcaemia. Arch Otolaryngol Head Neck Surg 2011;137: 1154–60CrossRefGoogle Scholar