Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia
Abstract
Background: Hypocalcaemia is common after thyroidectomy. Accurate prediction and appropriate management may help reduce morbidity and hospital stay. The aim of this study was to perform a systematic literature review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Methods: A systematic search of PubMed, EMBASE and the Cochrane Library databases was undertaken, and the quality of manuscripts assessed using a modified Newcastle–Ottawa Scale. Results: Some 115 observational studies were included. The median (i.q.r.) incidence of transient and permanent hypocalcaemia was 27 (19–38) and 1 (0–3) per cent respectively. Independent predictors of transient hypocalcaemia included levels of preoperative calcium, perioperative parathyroid hormone (PTH), preoperative 25-hydroxyvitamin D and postoperative magnesium. Clinical predictors included surgery for recurrent goitre and reoperation for bleeding. A calcium level lower than 1·88 mmol/l at 24 h after surgery, identification of fewer than two parathyroid glands (PTGs) at surgery, reoperation for bleeding, Graves' disease and heavier thyroid specimens were identified as independent predictors of permanent hypocalcaemia in multivariable analysis. Factors associated with transient hypocalcaemia in meta-analyses were inadvertent PTG excision (odds ratio (OR) 1·90, 95 per cent confidence interval 1·31 to 2·74), PTG autotransplantation (OR 2·03, 1·44 to 2·86), Graves' disease (OR 1·75, 1·34 to 2·28) and female sex (OR 2·28, 1·53 to 3·40). Conclusion: Perioperative PTH, preoperative vitamin D and postoperative changes in calcium are biochemical predictors of post-thyroidectomy hypocalcaemia. Clinical predictors include female sex, Graves' disease, need for parathyroid autotransplantation and inadvertent excision of PTGs.
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Supplementing oral calcium, vitamin D, or both preoperatively may reduce the risk of postoperative hypocalcemia due to parathyroid injury or increased bone turnover.
“Recent data suggest that supplementing oral calcium, vitamin D, or both preoperatively may reduce the risk of postoperative hypocalcemia due to parathyroid injury or increased bone turnover (188).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [188]
A meta-analysis identified preoperative vitamin D deficiency and GD itself as risk factors for postoperative hypocalcemia.
“A meta-analysis of risk factors for postoperative hypocalcemia identified preoperative vitamin D deficiency as a risk factor for postoperative hypocalcemia, as well as GD itself (188).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [188]
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Flagged first, then by citations
Research works printed but not linked: 1
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Cited by
Sorted by citations
Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., et al. (2016) · Thyroid® · doi:10.1089/thy.2016.0229 · Cited by 2,938 · see citing works
“A meta-analysis of risk factors for postoperative hypocalcemia identified preoperative vitamin D deficiency as a risk factor for postoperative hypocalcemia, as well as GD itself (188).”
BackgroundAntakia, R., Edafe, O., Uttley, L., & Balasubramanian, S. P. (2015) · Thyroid · doi:10.1089/thy.2014.0101 · Cited by 92 · see citing works
Self-citationKim, W. W., Chung, S.-H., Ban, E. J., Lee, C. R., Kang, S.-W., Jeong, J. J., Nam, K.-H., Chung, W. Y., & Park, C. S. (2015) · Thyroid · doi:10.1089/thy.2014.0522 · Cited by 49 · see citing works
- Authors
- Edafe, O., Antakia, R., Laskar, N., Uttley, L., & Balasubramanian, S. P.
- Affiliations
- University of Sheffield (GB)
- Corresponding author
- Edafe, O
- Venue
- British Journal of Surgery
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-01-09
- Volume
- 101
- Issue
- 4
- Pages
- 307-320
- ISSN
- 0007-1323 (ISSN-L)
- 1365-2168
- OpenAlex
- W1907167560
- Cited by
- 732
- References
- 123
- Citations by year
- 2026: 73 · 2025: 69 · 2024: 57 · 2023: 69 · 2022: 74 · 2021: 97 · 2020: 87 · 2019: 57 · 2018: 40 · 2017: 39 · 2016: 35 · 2015: 19 · 2014: 16
- FWCI
- 6.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- British journal of surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Keywords
- hypoparathyroidism, parathyroid hormone, parathyroid autotransplantation, vitamin D, Graves' disease, thyroidectomy, risk factors
- MeSH terms
- Calcium, Epidemiologic Methods, Female, Graves Disease, Humans, Hypocalcemia, Male, Parathyroid Glands, Parathyroid Hormone, Recurrence, Reoperation, Sex Factors, Thyroidectomy, Vitamin D, Perioperative Care
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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