Incidence and Risk Factors of Post-Thyroidectomy Hypocalcemia in a Tertiary Referral Hospital in Eastern Libya: A Retrospective Cohort Study

Abstract

Postoperative hypocalcemia remains the most frequent and challenging complication following thyroidectomy, leading to prolonged hospital stays, increased healthcare costs, and patient morbidity. However, regional data from Libya remain scarce. This retrospective cohort study aimed to evaluate the incidence of temporary and permanent hypocalcemia and to identify independent clinical and surgical risk factors among 75 consecutive adult patients who underwent total, near-total, or revision thyroidectomy at Benghazi Medical Center. Data collection encompassed patient demographics, surgical extent, retrosternal extension, histopathological diagnoses, and serial serum calcium levels. The overall incidence of temporary post-thyroidectomy hypocalcemia was 50.0%, while permanent hypocalcemia occurred in 3.7% of long-term cases. A statistically significant reduction was observed between preoperative (8.99 ± 1.15 mg/dL) and postoperative serum calcium levels (8.04 ± 1.19 mg/dL; p < 0.0001). Multivariable logistic regression analysis identified female gender as the sole independent predictor of temporary hypocalcemia (Adjusted Odds Ratio [aOR] = 5.64; 95% Confidence Interval: 1.05–30.30; p = 0.044), whereas age, surgical extent, and retrosternal extension showed no statistically significant association. Given that transient hypocalcemia affects half of the patients, routine perioperative calcium monitoring, proactive vitamin D optimization, and meticulous surgical preservation of the parathyroid glands are strongly recommended to improve clinical outcomes in regional tertiary care centers.