الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 87 |  |  |
| | | from | 87 | | |
Abstract
Control of post operative complications and minimizing the hospital stay are the most challenging issues that surgeons face allover the world After total thyroidectomy , postoperative hypocalcemia is a common complication. Hypocalcemia due to hypoparathyroidism may present clinically with peri-oral and peripheral paresthesias, muscle spasms, carpopedal spasm or tetany, and/or confusion . Regarding our study : In comparison between baseline data variations among patients age , sex , residence , chronic illness as : diabetes and hypertension , positive or negative family history of thyroid diseases , toxic manifestations and antithyroid drugs administration , they are all of no significance in decrease incidence of hypocalcemia . A BISWAS N.N., et al on tetany after thyroidectomy had noticed a relationship between gender and hypocalcemia : among 60 patients including 40 female , tetany occurred in 3 female patients to only one male patient . Clinical evaluation of the variability between the clinical manifestations : Local thyroid evaluation and general related vital data ex : blood pressure and pulse rate showed no correlation with the study aim . As stated by KRISHNAN RAVIKUMAR, et al on Role of Supplemental Oral Calcium and Vitamin D in Prevention of Post thyroidectomy Hypocalcemia cofirmed the same aspect Following post operative complications , only serum calcium level was markedly affected . Administiration of Vit D preoperative in group A showed excellent role in decreasing incidence of post thyroidectomy hypocalcemia . Only 3 patients (6%) received vit D preoperative have developed hypocalcemia , but 14 patients (28%) with no preoperative vit D administration have Previous studies suggest that the administration of vit D supplements prevents the development of hypocalcemia after thyroid surgery. Bellantone et al. also demonstrated that vitamin D supplements resulted in a significantly higher serum calcium concentrations on the second and the third postoperative days thus, decreasing the incidence of hypocalcemia . 8% of the patients who received vit D developed post operative hypocalcemia in comparison to 22% in the other group (6) According to a study conducted by Baldassarre et al., the incidence of hypocalcemia after thyroidectomy was 5.5%. Our study shows that the administisration of preoperative vitamin D supplements can reduce the incidence of hypocalcemia after total thyroidectomy by 16% . In fact, this treatment avoided a significant decrease in serum calcium levels . Many biochemical markers are being used to predict the development of hypocalcemia after thyroid surgery to reduce the length of the hospital stay . Although serum calcium assay has been used to predict the development of hypocalcemia after the thyroid surgery; however, due to postoperative hemodilution, the measurement of total serum calcium may yield inaccurate results . The prevention of postoperative hypocalcemia will lead to a significant decrease in the length of stay in the hospital. Roh and Park demonstrated that administration of vitamin D reduces the incidence and even severity of hypocalcemia after total thyroidectomy . Sanabria et al. evaluated four randomized clinical trials in a meta-analysis. They found that the administration of vitamin D supplements decreases the incidence of hypocalcemia symptoms after thyroidectomy . The main preventive measure is preserving parathyroid glands by careful dissection during the surgery; also parathyroid autotransplantation has been shown to prevent permanent hyperparathyroidism after total, subtotal, or completion thyroidectomy for benign or malignant diseases of the thyroid gland. Abboud et al. conducted a retrospective study involving 252 patients who underwent total thyroidectomy. They found that routine autotransplantation of at least one parathyroid gland along with routine vitamin D supplementation during total thyroidectomy efficiently reduced symptomatic hypocalcemia and permanent hyperparathyroidism . Our study confirms that postoperative hypocalcemia may develop in all age groups in both males and females who undergo thyroidectomy without preoperative vitamin D supplements. Preoperative vitamin D supplements may prevent postoperative hypocalcemia, allowing a safe and early discharge from the hospital. This will ultimately lead to improved patient satisfaction and significant cost savings. This will also lead to a decreased length of hospital stay as postoperative hypocalcemia lengthens the stay in the hospital. Avoiding post operative complication is still the chief challenge in our job . Hypocalcemia is one of the urgent , even life-threatening , complication in cases of multinodular , toxic or malignant goiters having total thyroidectomies . Vitamin D is a main factor in the process of body regulation of serum calcium level . Previously it was used for treatment of actually occurring hypocalcemia in conjugation with calcium supplementations . Our study is caring for the prophylactic role od vitamin D , not only treatss but also decreases the incidence of post thyroidectomy hypocalcemia . The patient is given 200,000 IU of vitamin D only 24 hours before surgery . A marked decrease in the incidence of hypocalcemia in the group received vitamin D confirms the prophylactic role of vitamin D administration keeping in mind other related factors : preservation of the parathyroid glands during dissection comes to the top . Monitoring of sudden severe post operative symptoms of hypocalcemia is an emergency . chronic hypocalcemic patients must br lined for oral calcium and vitamin D supplementations with laboratory follow up of calcium level.