Guidelines for Complications of Cancer Treatment Vol VIII Part B

Prevention Thorough knowledge of the thyroid-parathyroidanatomy. Meticulous surgical procedure. Capsular ligation of branches of the inferior thyroidartery as opposed to truncal ligation, may decrease ratesof hypocalcemia A drop of 75% baseline PTH or Postoperative PTHbelow 7-15pg/mL is considered as predictors for futurehypocalcaemia. Scenario of Unavoidable/Accidental damage toparathyroids – Parathyroid auto transplantation (PTHAT) Preferred site – Sternocleidomastoid. In case of extensive neck dissections, can usepectoralis major for implantation. In cases of surgery for medullary thyroid cancerassociated with MEN II A & IIB – Forearm is thepreferred choice.* PTHAT – After confirming the cut tissue is parathyroid glandin frozen section, 1mm slices of removed parathyroid glandare prepared and these are inserted into a pocket made in thesternocleidomastoid muscle.Management of hypocalcaemia:Depends on severity and presenting symptoms.Mainstay of treatment - Symptomatic patients require ivcalcium + oral calcium & Vit D3.Asymptomatic patients can be managed with oral supplementsalone.*It is also essential to measure serum magnesium in any patientwho is hypocalcaemic, as correction of hypomagnesaemia mustbe done to overcome PTH resistance before serum calciumwill return to normal.200