Implications of Retrosternal Extension on Postoperative Serum Calcium Levels Following Total Thyroidectomy: A Retrospective Study.

Introduction:  Total thyroidectomy is a common surgery in otorhinolaryngology, with hypocalcemia being a potential complication, either transient or permanent. Calcium plays a critical role in many physiological processes, including nerve transmission, cardiac function, and muscle activity. Postoperative hypocalcemia can occur within 48 hours or be delayed up to four days. Risk factors include thyroid size, vascularity, retrosternal extension, and surgical extent. Timely treatment is essential, especially in acute cases, to avoid long-term complications. The objective of the study is to evaluate the impact of retrosternal extension and central compartment clearance on postoperative hypocalcemia in patients undergoing total thyroidectomy and the duration and severity of hypocalcemia.

Methods: A retrospective analysis was conducted on patients who underwent total thyroidectomy at a tertiary rural hospital from January 2016 to June 2024. Patients were categorized into two groups: those with retrosternal extension and/or central compartment clearance and those without. Postoperative serum calcium levels were documented over four days post-surgery, and the incidence and duration of hypocalcemia were compared between the groups.

Results: Out of 69 patients, 21 (30.4%) developed hypocalcemia postoperatively. Patients with retrosternal extension had a higher incidence of hypocalcemia (odds ratio = 3.58) compared to those without. Additionally, patients with central compartment clearance showed a higher risk of early postoperative hypocalcemia. The severity of hypocalcemia was greater in patients with malignancy and more extensive surgical procedures. Recovery time varied, with some patients requiring long-term calcium supplementation beyond one year.

Conclusion: Retrosternal extension and central compartment clearance significantly increase the risk of postoperative hypocalcemia. Although not statistically significant, the trends suggest a need for careful surgical techniques and rigorous postoperative calcium management to prevent prolonged hypocalcemia. Further prospective studies are recommended to confirm these findings and improve postoperative care strategies.