الفهرس 
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Abstract
A
total of 20 patients (18 women and 2 men) underwent thyroidectomy over the study period. Patient age ranged from 29 to 61 years with a median age of 45 years. The patients signed a consent form and had a full knowledge of the study beforehand. Inclusion and exclusion criteria were considered. Pre-operative and post-operative care were given fully according to the guidelines. The results were recorded and the patients had full reports of their conditions and follow up was done 1 months and 6 months later to detect post-operative permanent hypocalcemia.
Hypocalcemia is the most common complication after total thyroidectomy. Although the reported frequency is probably low because the usual practice of administering calcium supplements to all patients to allow for early discharge may mask the real frequency of hypocalcaemia in real practice. In addition, this practice means that a high percentage of patients take unnecessary calcium prescriptions, which are impractical and could in some cases, increase the incidence of other complications like the risk of constipation, promote the development of calcium kidney stones, and inhibit iron and zinc absorption from oral intake.
Clinically significant hypocalcaemia is a common complication after bilateral thyroid resection. Clinically significant hypocalcaemia is a common concern after bilateral thyroid resection. Usually, close monitoring of serum calcium levels has been used to monitor postoperative hypocalcaemia. However, because the development of postoperative hypocalcaemia can be presented late as 24 hours to several days after surgery, many surgeons have suggested prolonged hospitalization to monitor serum calcium levels, in order to prevent potential readmission for symptomatic hypocalcaemia. However, this requires calcium monitoring at least until the morning after thyroidectomy, against same-day discharge. This approach was considered not to be cost-effective. Thus, same-day surgery 24-hour observation after thyroidectomy has been suggested as a means of cost reduction for thyroidectomy and proper follow up.
The management of patients after total thyroidectomy focuses on close observation for the uncommon event of postoperative hemorrhage and monitoring for hypocalcaemia which results from impaired parathyroid gland function. In expert hands, after total thyroidectomy, temporary hypo-parathyroidism occurs in 10–30% of cases and permanent hypo-parathyroidism should be in the order of approximately 1–2%. The detection of postoperative hypo-parathyroidism has traditionally been by the serial measurement of corrected serum calcium concentrations and requires multiple veins punctures and potentially several days of hospitalization after the procedure.
The clinical signs of hypocalcaemia are not always reproducible or reliable. Reliance on the measurement of serum calcium concentrations frequently results in the delayed detection of hypocalcaemia.
The early detection of hypo-parathyroidism may therefore facilitate decision-making regarding the need for calcium supplementation, thereby shortening length of hospital stay and decreasing number of blood tests.
With the advent of postoperative monitoring of PTH levels the thyroid surgeons have the potential to discharge patients earlier than the current standard if they have PTH measurement directly after thyroidectomy. When PTH value fell significantly after 10 minutes from thyroidectomy, there is an extremely high likelihood of developing hypocalcaemia, and supplementation could have been started earlier with the probability for earlier discharge (instead of waiting for patients to become symptomatic). This approach allow for safe early discharge from hospital.
By applying this study the junior staff could have a chance to increase their learning curve and dependability in the surgical ward as they are supervised by the professors. Given the statistical analysis the results are nearly the same regarding this study and previous studies. As it is shown that 25% of the patients in our study had transient hypocalcemia while no permanent hypoparathyroidism are detected in our study.