Management of hypocalcemia after modified bilateral radical neck dissection followed with total thyroidectomy: a case report


  • I Made Arimbawa Department of Child Health, Medical Faculty, Udayana University, Indonesia
  • Ayu Diah Perdana Paramita Department of Child Health, Medical Faculty, Udayana University, Indonesia
  • I Gde Ardika Nuaba Department of Ear, Nose, Throat-Head and Neck Surgery, Medical Faculty, Udayana University, Indonesia
  • Herman Saputra Department of Pathological Anatomy, Medical Faculty, Udayana University, Indonesia


calcitriol, calcium, hypocalcemia, hypoparathyroidism, hypovitaminosis


Hypocalcemia is a common complication after total thyroidectomy due to acute hypoparathyroidism post-surgery. The incident varies from 7%-69% depends on the surgery center. The management is divided based on the onset and symptoms. Carpal-pedal spasm, seizure, bronchospasms are the emergency symptoms of hypocalcemia that require administration of intravenous calcium. However, the management of asymptomatic hypocalcemia with oral calcium, vitamin D, and hydrochlorothiazide can be difficult due to wide fluctuations of serum calcium and the risks of complication. Hereby we report a 14-year-old girl with hypocalcemia due to hypoparathyroidism post modified bilateral radical neck dissection and total thyroidectomy. She had papillary thyroid carcinoma and lymph node metastases. After surgery, she developed classic signs of hypocalcemia, numbness in extremities which progressed to cramps. Physical examination revealed chvostek’s sign. Laboratory examination showed the critical value of hypocalcemia with a normal level of albumin, hypoparathyroidism, and hypovitaminosis D. The initial treatment was started by giving intravenous calcium gluconate 10% and calcitriol. Monitoring levels of calcium and phosphate were performed regularly. Calcium level was maintained by giving a high dose of elemental calcium, vitamin D3 and hydrochlorothiazide followed.


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Abboud, B., Sargi, Z., Akkam, M., & Sleilaty, F. (2002). Risk factors for postthyroidectomy hypocalcemia. Journal of the American College of Surgeons, 195(4), 456-461.

Aboelnaga, E. M., & Ahmed, R. A. (2015). Difference between papillary and follicular thyroid carcinoma outcomes: an experience from Egyptian institution. Cancer biology & medicine, 12(1), 53.

Alhefdhi, A., Mazeh, H., & Chen, H. (2013). Role of postoperative vitamin D and/or calcium routine supplementation in preventing hypocalcemia after thyroidectomy: a systematic review and meta-analysis. The Oncologist, 18(5), 533.

Alsubhi, H. M., Yousef, F. M., Almarzouki, H. Z., & Sindi, H. A. (2018). Effect of Vitamin D and Calcium Supplementations on Reducing the Incidence of Hypocalcemia after Thyroidectomy. World Journal of Medical Sciences, 15(2), 69-75.

Baumgarten, H. D., Bauer, A. J., Isaza, A., Mostoufi-Moab, S., Kazahaya, K., & Adzick, N. S. (2019). Surgical management of pediatric thyroid disease: Complication rates after thyroidectomy at the Children's Hospital of Philadelphia high-volume Pediatric Thyroid Center. Journal of pediatric surgery, 54(10), 1969-1975.

Cho, N. L., Moalem, J., Chen, L., Lubitz, C. C., Moore Jr, F. D., & Ruan, D. T. (2014). Surgeons and Patients Disagree on the Potential Consequences of Hypoparathyroidism. Endocrine Practice, 20(5), 427-446.

Dedivitis, R. A., Aires, F. T., & Cernea, C. R. (2017). Hypoparathyroidism after thyroidectomy: prevention, assessment and management. Current opinion in otolaryngology & head and neck surgery, 25(2), 142-146.

Di Maio, S., Soliman, A. T., De Sanctis, V., & Kattamis, C. (2018). Current treatment of hypoparathyroidism: theory versus reality waiting guidelines for children and adolescents. Acta Bio Medica: Atenei Parmensis, 89(1), 122.

Freire, A. V., Ropelato, M. G., Ballerini, M. G., Acha, O., Bergadá, I., de Papendieck, L. G., & Chiesa, A. (2014). Predicting hypocalcemia after thyroidectomy in children. Surgery, 156(1), 130-136.

Limaiem, F., Rehman, A., & Mazzoni, T. (2019). Cancer, papillary thyroid carcinoma (PTC). StatPearls [Internet].

Maxwell, A. K., Shonka, D. C., Robinson, D. J., & Levine, P. A. (2017). Association of preoperative calcium and calcitriol therapy with postoperative hypocalcemia after total thyroidectomy. JAMA Otolaryngology–Head & Neck Surgery, 143(7), 679-684.

Mejia M.G., Gonzalez-Devia, D., Fierro, F., Tapiero, M., Rojas, L., Cadena, E. (2018). Hypocalcemia posthyroidectomy: prevention, diagnosis and management. J Transl Sci, 4(2), 1-7.

Reinhardt, T. A., Lippolis, J. D., McCluskey, B. J., Goff, J. P., & Horst, R. L. (2011). Prevalence of subclinical hypocalcemia in dairy herds. The Veterinary Journal, 188(1), 122-124.

Ritter, K., Elfenbein, D., Schneider, D. F., Chen, H., & Sippel, R. S. (2015). Hypoparathyroidism after total thyroidectomy: incidence and resolution. journal of surgical research, 197(2), 348-353.

Stack, B.J., Bimston, D.N., Bodenner, D.L., Brett, E.M., Dralle, H., Orloff, L.A., et al. (2015). American association of clinical endocrinologists and American college of endocrinology disease state clinical review: postoperative hypoparathyroidism – definition and management. Endocr Pract, 21(6), 674-83.

Tolone, S., Roberto, R., del Genio, G., Brusciano, L., Parmeggiani, D., Amoroso, V., ... & Docimo, L. (2013). The impact of age and oral calcium and vitamin D supplements on postoperative hypocalcemia after total thyroidectomy. A prospective study. BMC surgery, 13(2), 1-6.



How to Cite

Arimbawa, . I. M., Paramita, A. D. P., Nuaba, I. G. A., & Saputra, H. (2021). Management of hypocalcemia after modified bilateral radical neck dissection followed with total thyroidectomy: a case report. International Journal of Health Sciences, 5(1), 9-19.



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