Postoperative Hypocalcemia Following Total Thyroidectomy Versus Completion Thyroidectomy
Mehmet Turan Cicek, Çiğdem Firat Koca, Mehmet Tan, Baransel AlganABSTRACT
Objective
This study compares the incidence of postoperative hypocalcemia in primary total thyroidectomy (TT) versus completion thyroidectomy (CT). Additionally, it assesses the impact of age, sex, smoking, comorbidities, and length of hospital stay on outcomes.
Material‐Methods
This retrospective cohort study included 48 patients (24 TT, 24 CT) operated on between 2018 and 2025. Patients were matched 1:1 for age and gender. Preoperative and postoperative day 1 (POD 1) calcium and parathyroid hormone (PTH) levels were analyzed. A minimum interval of 3 months was maintained for the CT group.
Results
No significant differences were observed regarding demographics, comorbidities, or length of hospital stay. While POD 1 serum calcium levels were similar, postoperative PTH levels were significantly higher in the CT group (51.90 ± 30.26 pg/mL) compared to the TT group (30.90 ± 17.10 pg/mL) ( p = 0.006). Calcium supplementation was significantly higher in the TT group (25.0%) than in the CT group (4.2%) ( p = 0.049). Incidental parathyroid excision was more frequent in the TT group (37%) than the CT group (20%). Higher PTH levels in the CT group suggest that leaving the contralateral side undisturbed initially provides a physiological advantage in vascularization.
Conclusions
Completion thyroidectomy is associated with improved postoperative parathyroid function and a decreased risk of transient hypocalcemia compared to total thyroidectomy. A staged surgical approach provides a strategic advantage in preserving parathyroid function and reducing the need for calcium supplementation compared to immediate bilateral resection.
Level of Evidence
3