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: 140-146
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Response to: The timing of calcium measurements in helping to predict temporary and permanent hypocalcaemia in patients having completion and total thyroidectomies Gadepalli C, Sanghera S, Hargreaves S 14 Aug 09 |
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We read this recent article with great interest. The senior author in our department frequently performs total completion thyroidectomies and pararthyroidectomies. We follow the same protocol of checking serum calcium six hours postoperatively and on the first postoperative day. We agree with the authors that this is a very useful protocol in management of postoperative hypocalcaemia, in predicting both short and long-term hypocalcaemia. However, the authors have failed to address hypomagnesaemia as a cause of refractory hypocalcaemia. Transient hypocalcaemia and hypomagnesaemia are known to occur frequently after total thyroidectomy.1 Serum calcium is checked routinely after total thyroidectomy, completion thyroidectomy and pararthyroidectomies. We advocate checking serum magnesium in patients refractory to intravenous calcium and those at risk. Poor nutrition associated with chronic alcohol use, prolonged diarrhoea, treatment with diuretics and certain chemotherapeutics (such as cisplatin) causes hypomagnesaemia.2 Serum magnesium is important for the synthesis and release of parathyroid hormone.3 Recognition of hypomagnesaemia is important in this setting as it is difficult to reverse hypocalcaemia without magnesium repletion in turn affecting short and long-term hypocalcaemia. References
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Original author's response Pfleiderer A 14 Aug 09 |
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We appreciate the comments made by Gadepalli and Hargreaves regarding the role of hypomagnesaemia and therefore the need to consider checking magnesium levels in cases of refractory hypocalcaemia following total thyroidectomy. However, as we did not come across this scenario in our series and the thrust of the article was focused on the timing of calcium measurements, we did not refer to this issue in our report. |
