Preventive Effect of Dexamethasone Therapy on the Transient Hypoparathyroidism through Total Thyroidectomy

Document Type : Original


1 Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

2 Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.


This study aimed to investigate whether pre-operative dexamethasone could ameliorate transient hypoparathyroidism outcome through total thyroidectomy.
Materials and Methods:
This randomized clinical trial study was conducted on 128 patients underwent total thyroidectomy from March 2014 to April 2015. Patients were randomly assigned to two groups of experimental receiving 8 mg IV of intravenous dexamethasone (n=45) 45 min before skin incision treatment and control (n=83). After the surgery, all patients were evaluated for clinical and laboratory hypocalcaemia.
Post-operative transient biochemical hypoparathyroidism and hypocalcaemia did not occur more often in the control group, compared to the dexamethasone group while controlling for the baseline variables. However, there was a significant difference in phosphorus level between the dexamethasone and control groups (P=0.028). A total of 50 (39.1%) patients developed hypocalcaemia after surgery. Moreover, post-operative symptomatic hypocalcemia occurred more frequently in the control group (68%) compared to the dexamethasone group (32%); however, this difference was not statistically significant (P=0.54).
The pre-operative administration of dexamethasone reduced post-operative hypocalcemia rate. It is essential to conduct future studies with validated means for better results.


Main Subjects

1. Bron L, O'Brien C. Total thyroidectomy for clinically benign disease of the thyroid gland. British journal of surgery. 2004;91(5):569-74.
2. Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World journal of surgery. 2004;28(3):271-6.
3. Dener C. Complication rates after operations for benign thyroid disease. Acta oto-laryngologica. 2002;122(6):679-83.
4. Thomusch O, Sekulla C, Dralle H. [Is primary total thyroidectomy justified in benign multinodular goiter? Results of a prospective quality assurance study of 45 hospitals offering different levels of care]. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 2003; 74(5): 437-43.
5. Falk SA, Birken EA, Baran DT. Temporary postthyroidectomy hypocalcemia. Archives of Otolaryngology-Head & Neck Surgery.1988;114 (2): 168-74.
6. Percival RC, Hargreaves AW, Kanis JA. The mechanism of hypocalcaemia following thyroidectomy. Acta endocrinologica. 1985; 109 (2): 220-6.
7. See A, Soo K. Hypocalcaemia following thyroidectomy for thyrotoxicosis. British journal of surgery. 1997;84(1):95-7.
8. Falk S. Complications of Thyroid Surgery: Hypocalcemia, Hypoparathyroidism. Thyroid disease: Endocrinology, Surgery, Nuclear Medicine, Radiotherapy-Raven Press, New York. 1990: 609-20.
9. Reeve T, Thompson NW. Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World journal of surgery. 2000; 24(8):971-5.
10. Asari R, Passler C, Kaczirek K, Scheuba C, Niederle B. Hypoparathyroidism after total thyroidectomy: a prospective study. Archives of Surgery. 2008;143(2):132-7.
11. Tredici P, Grosso E, Gibelli B, Massaro M, Arrigoni C, Tradati N. Identification of patients at high risk for hypocalcemia after total thyroidectomy. Acta Otorhinolaryngologica Italica. 2011;31(3):144.
12. Cavicchi O, Piccin O, Caliceti U, De Cataldis A, Pasquali R, Ceroni AR. Transient hypoparathyroidism following thyroidectomy: a prospective study and multivariate analysis of 604 consecutive patients. Otolaryngology-Head and Neck Surgery. 2007;137(4):654-8.
13. Srinivasa S, Kahokehr AA, Yu T-C, Hill AG.  pre-operative Glucocorticoid Use in Major Abdominal Surgery: Systematic Review and Meta-Analysis of Randomized Trials. Annals of surgery. 2011;254(2):183-91.
14. Holte K, Kehlet H. Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. Journal of the American College of Surgeons. 2002;195(5):694-712.
15. Sapolsky RM, Romero LM, Munck AU. How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions 1. Endocrine reviews. 2000; 21(1):55-89.
16. Schietroma M, Cecilia EM, Carlei F, Sista F, De Santis G, Lancione L, et al. Dexamethasone for the prevention of recurrent laryngeal nerve palsy and other complications after thyroid surgery: a randomized double-blind placebo-controlled trial. JAMA Otolaryngology–Head & Neck Surgery. 2013;139(5):471-8.
17. Feroci F, Rettori M, Borrelli A, Lenzi E, Ottaviano A, Scatizzi M. Dexamethasone prophylaxis before thyroidectomy to reduce  post-operative nausea, pain, and vocal dysfunction: a randomized clinical controlled trial. Head Neck.2011 Jun;33(6):840-6. doi(2010 Aug 24): 10. 1002/ hed.21543.
18. Lachanas VA, Exarchos S, Tsiouvaka S, Tsea M, Hajiioannou JK, Skoulakis CE, et al. Does perioperative dexamethasone affect voice-related quality of life after thyroidectomy? European Archives of Oto-Rhino-Laryngology. 2014; 271 (11):3073-6.
19. Yang C, Jung SM, Bae YK, Park SJ. The effect of ketorolac and dexamethasone on the incidence of sore throat in women after thyroidectomy: a prospective double-blinded randomized trial. Korean J Anesthesiol.2017 Feb;70(1):64-71. doi(2016 Nov 25):10.4097/kjae.2017.70.1.64.
20. Tarantino I, Warschkow R, Beutner U, Kolb W, Luthi A, Luthi C, et al. Efficacy of a Single  pre-operative Dexamethasone Dose to Prevent Nausea and Vomiting After Thyroidectomy (the tPONV Study): A Randomized, Double-blind, Placebo-controlled Clinical Trial. Ann Surg. (10):2015 Dec; 262(6):934-40.
21. Zambudio AR, Rodríguez J, Riquelme J, Soria T, Canteras M, Parrilla P. Prospective study of  post-operative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery.Annals of surgery.2004;240 (1): 18-25.
22. Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau J-L, et al. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World journal of surgery. 1998; 22(7): 718-24.
23. Wang L-F, Lee K-W, Kuo W-R, Wu C-W, Lu S-P, Chiang F-Y. The efficacy of intraoperative corticosteroids in recurrent laryngeal nerve palsy after thyroid surgery. World journal of surgery. 2006;30(3):299-303.
24. Mayers I, Johnson D. The nonspecific inflammatory response to injury. Canadian journal of anaesthesia. 1998;45(9):871-9.
25. Nasiri S, Shafag S, Khorgami Z, Sodagari N, Aminian A, Hedayat A. Does corticosteroid have any beneficial effect on voice change after thyroidectomy? The American Surgeon. 2013; 79(12):1258-62.
26. Hermann M, Ott J, Promberger R, Kober F, Karik M, Freissmuth M. Kinetics of serum parathyroid hormone during and after thyroid surgery. British journal of surgery. 2008; 95(12): 1480-7.
27. Mazotas IG, Wang TS. The role and timing of parathyroid hormone determination after total thyroidectomy. Gland surgery. 2017;6(Suppl 1): S38.
28. Edafe O, Balasubramanian SP. Incidence, prevalence and risk factors for post-surgical hypocalcaemia and hypoparathyroidism. Gland surgery. 2017;6(Suppl 1):S59.
29. Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg.2014 Mar;101(4):307-20. doi(2014 Jan 9):10.1002/bjs.9384.
30. Cheng S-P, Liu T-P, Yang P-S, Lee K-S, Liu C-L. Effect of perioperative dexamethasone on subjective voice quality after thyroidectomy: a meta-analysis and systematic review. Langenbeck's Archives of Surgery. 2015;400(8):929-36.
31. Donnelly LE, Newton R, Kennedy GE, Fenwick PS, Leung RH, Ito K, et al. Anti-inflammatory effects of resveratrol in lung epithelial cells: molecular mechanisms. American Journal of Physiology-Lung Cellular and Molecular Physiology. 2004;287(4):L774-L83.
32. Zou Z, Jiang Y, Xiao M, Zhou R. The impact of prophylactic dexamethasone on nausea and vomiting after thyroidectomy: a systematic review and meta-analysis. PLoS One. 2014;9(10):e109582.