ABSTRACT

Early postoperative calcium levels were evaluated following total thyroidectomy with respect to bilateral inferior thyroid artery truncal ligation and reccurent laryngeal nerve dissection.

Ninety two patients with multinodular goitre were treated with total thyroidectomy, and randomised according to the study protocol. Bilateral inferior thyroid artery truncal ligation together with dissection of recurrent laryngeal nerve was performed in group 1 (no:40). In group 2 patients (n:52), Inferior thyroid artery was ligated at the level of the thyroid gland entrance and dissection of nervus laryngeus inferior was not performed. The calcium levels were obtained 12 hours before and 24.72 hours after the operation.

There were no significant differences in age, gender, operating time and hospitalisation time between the two groups. The calcium levels were similar in both groups at preoperative, first postoperative day and third postoperative day (p=0.07; p=0.29; p=0.51, respectively). The calcium level of group 1 at postoperative first day (p<0.018) and the calcium level of group 2 at postoperative third day (p<0.002) were istatistically lower from levels measured in preoperative period. Postoperative Chvostek and Trousseau signs were positive in 4 patients of group 1 (10%) and 5 patients of group 2 (9.5%) (p=0.71). None of the patients developed aphonia and respiratory distress.

Truncal ligation of inferior thyroid artery together with recurrent laryngeal nerve dissection does not cause prominent hypocalcemia, when compared with the ligation of thyroid artery at the level of entering the thyroid gland and nondissected recurrent laryngeal nerve. During the postoperative period, both methods cause similar rates of early hypocalcemia. In fact, these maneuvers did not cause either disphonia/aphonia or respiratory distress after total thyroidectomy. (JAREM 2014; 2: 69-73)