Hipocalcemia post- tiroidectomía total: análisis de dosis para suplemento rutinario profiláctico

ilustraciones, tablas

Autores:: Gómez Gutiérrez, Carlos Andrés

Tipo de recurso:

Fecha de publicación:: 2022

Institución:: Universidad Nacional de Colombia

Repositorio:: Universidad Nacional de Colombia

Idioma:: spa

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dc.title.spa.fl_str_mv	Hipocalcemia post- tiroidectomía total: análisis de dosis para suplemento rutinario profiláctico
dc.title.translated.eng.fl_str_mv	Hypocalcemia following total thyroidectomy: an analysis of dose for prophylactic routinary substitution
title	Hipocalcemia post- tiroidectomía total: análisis de dosis para suplemento rutinario profiláctico
spellingShingle	Hipocalcemia post- tiroidectomía total: análisis de dosis para suplemento rutinario profiláctico 610 - Medicina y salud::617 - Cirugía, medicina regional, odontología, oftalmología, otología, audiología Hipocalcemia Tiroidectomía/rehabilitación Prevención de Enfermedades Hypocalcemia Thyroidectomy/rehabilitation Disease Prevention Thyroidectomy Hypocalcemia Calcium carbonate Calcitriol Hypercalcemia Tiroidectomía Hipocalcemia Carbonato de calcio Calcitriol Hipercalcemia
title_short	Hipocalcemia post- tiroidectomía total: análisis de dosis para suplemento rutinario profiláctico
title_full	Hipocalcemia post- tiroidectomía total: análisis de dosis para suplemento rutinario profiláctico
title_fullStr	Hipocalcemia post- tiroidectomía total: análisis de dosis para suplemento rutinario profiláctico
title_full_unstemmed	Hipocalcemia post- tiroidectomía total: análisis de dosis para suplemento rutinario profiláctico
title_sort	Hipocalcemia post- tiroidectomía total: análisis de dosis para suplemento rutinario profiláctico
dc.creator.fl_str_mv	Gómez Gutiérrez, Carlos Andrés
dc.contributor.advisor.spa.fl_str_mv	Zúñiga Pavia, Sergio Fabián
dc.contributor.author.spa.fl_str_mv	Gómez Gutiérrez, Carlos Andrés
dc.subject.ddc.spa.fl_str_mv	610 - Medicina y salud::617 - Cirugía, medicina regional, odontología, oftalmología, otología, audiología
topic	610 - Medicina y salud::617 - Cirugía, medicina regional, odontología, oftalmología, otología, audiología Hipocalcemia Tiroidectomía/rehabilitación Prevención de Enfermedades Hypocalcemia Thyroidectomy/rehabilitation Disease Prevention Thyroidectomy Hypocalcemia Calcium carbonate Calcitriol Hypercalcemia Tiroidectomía Hipocalcemia Carbonato de calcio Calcitriol Hipercalcemia
dc.subject.decs.spa.fl_str_mv	Hipocalcemia Tiroidectomía/rehabilitación Prevención de Enfermedades
dc.subject.decs.eng.fl_str_mv	Hypocalcemia Thyroidectomy/rehabilitation Disease Prevention
dc.subject.proposal.eng.fl_str_mv	Thyroidectomy Hypocalcemia Calcium carbonate Calcitriol Hypercalcemia
dc.subject.proposal.spa.fl_str_mv	Tiroidectomía Hipocalcemia Carbonato de calcio Calcitriol Hipercalcemia
description	ilustraciones, tablas
publishDate	2022
dc.date.accessioned.none.fl_str_mv	2022-03-03T21:35:21Z
dc.date.available.none.fl_str_mv	2022-03-03T21:35:21Z
dc.date.issued.none.fl_str_mv	2022
dc.type.spa.fl_str_mv	Trabajo de grado - Especialidad Médica
dc.type.driver.spa.fl_str_mv	info:eu-repo/semantics/masterThesis
dc.type.version.spa.fl_str_mv	info:eu-repo/semantics/acceptedVersion
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status_str	acceptedVersion
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dc.identifier.instname.spa.fl_str_mv	Universidad Nacional de Colombia
dc.identifier.reponame.spa.fl_str_mv	Repositorio Institucional Universidad Nacional de Colombia
dc.identifier.repourl.spa.fl_str_mv	https://repositorio.unal.edu.co/
url	https://repositorio.unal.edu.co/handle/unal/81127 https://repositorio.unal.edu.co/
identifier_str_mv	Universidad Nacional de Colombia Repositorio Institucional Universidad Nacional de Colombia
dc.language.iso.spa.fl_str_mv	spa
language	spa
dc.relation.indexed.spa.fl_str_mv	Bireme
dc.relation.references.spa.fl_str_mv	Christou N, Mathonnet M. Complications after total thyroidectomy. J Visc Surg. 2013 Sep 1;150(4):249–56. https://doi.org/10.1016/j.jviscsurg.2013.04.003 Orloff LA, Wiseman SM, Bernet VJ, Fahey Iii TJ, Shaha AR, Shindo ML, et al. American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults. THYROID [Internet]. 2018 [cited 2021 Aug 31];28(7). Available from: www.liebertpub.com https://doi.org/10.1089/thy.2017.0309 Pãduraru DN, Ion D, Carsote M, Andronic O, Bolocan A. Post-thyroidectomy Hypocalcemia-Risk Factors and Management. Chirurgia. 2019; 114(5):564-570. doi: 10.21614/chirurgia.114.5.564 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 J Surg. 2000;24:971–5. https://doi.org/10.1007/s002680010160 Lorente-Poch L, Sancho JJ, Luis Muñoz-Nova J, Sánchez-Velázquez P, Sitges-Serra A. Defining the syndromes of parathyroid failure after total thyroidectomy. Gland Surg. 2015 Feb;4(1):82-90. doi: 10.3978/j.issn.2227-684X.2014.12.04. Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, et al. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf). 2014 Jul;81 Suppl 1:1-122. doi: 10.1111/cen.12515 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;101(4):307–20. https://doi.org/10.1002/bjs.9384 Mejía, M. G., Vega, M. P., & Hakim, J. H. (2019). Prevalencia de hipocalcemia postiroidectomía en cirugía de cáncer de tiroides. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 6(2), 80–85. https://doi.org/10.53853/encr.6.2.481 Sanabria, Álvaro; Gómez, X.; Domínguez, L. C.; Vega, V.; Osorio, C. Tiroidectomía Total Basada En La Evidencia, análisis De Impacto Presupuestario. Rev Colomb Cir 2012, 27, 30-39. Patel KN, Yip L, Lubitz CC, Grubbs EG, Miller BS, Shen W, et al. Executive Summary of the American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg. 2020 Mar 1;271(3):399–410. https://doi.org/10.1097/SLA.0000000000003735 Xing T, Hu Y, Wang B, Zhu J. Role of oral calcium supplementation alone or with vitamin D in preventing post-thyroidectomy hypocalcaemia A meta-analysis. Medicine (Baltimore) . 2019 Feb;98(8):e14455. doi: 10.1097/MD.0000000000014455 Qin Y, Sun W, Wang Z, Dong W, He L, Zhang T, et al. A Meta-Analysis of Risk Factors for Transient and Permanent Hypocalcemia After Total Thyroidectomy. Front Oncol . 2021 Feb 24;10:614089. doi: 10.3389/fonc.2020.614089. eCollection 2020. Pepe J, Colangelo • Luciano, Biamonte F, Sonato C, Danese VC, Cecchetti V, et al. Diagnosis and management of hypocalcemia. Endocrine. 2020 sep;69(3):485-495. doi: 10.1007/s12020-020-02324-2 Goltzman D. Approach to Hypercalcemia. Endotext [Internet]. 2019 Oct 29 [cited 2021 Aug 31]; disponible en: https://www.ncbi.nlm.nih.gov/books/NBK279129 Lukinović J, Bilić M. OveRview Of ThyROid SuRgeRy COmpliCATiOnS. Acta Clin Croat. 2020 Jun; 59(Suppl 1): 81–86. doi: 10.20471/acc.2020.59.s1.10 Cho, J. N., Park, W. S., & Min, S. Y. (2016). Predictors and risk factors of hypoparathyroidism after total thyroidectomy. International journal of surgery (London, England), 34, 47–52. https://doi.org/10.1016/j.ijsu.2016.08.019 Al-Dhahri SF, Mubasher M, Al-Muhawas F, Alessa M, Terkawi RS, Terkawi AS. Early Prediction of Oral Calcium and Vitamin D Requirements in Post-thyroidectomy Hypocalcaemia. Otolaryngol Head Neck Surg. 2014 Sep;151(3):407-14. doi: 10.1177/0194599814536848 Huguet I. Postoperative thyroid hypocalcemia diagnosis and management protocol. Rev Osteoporos Metab Miner. 2020; 12 (2): 71-76. DOI: 10.4321/S1889-836X2020000200006 Vijay Nemade S, Vasant Rokade V, Aniruddha Pathak N, Sushil Tiwari S, Jayant Sonkhedkar S. Comparison Between Perioperative Treatment with Calcium and with Calcium and Vitamin D in Prevention of Post Thyroidectomy Hypocalcemia. Indian J Otolaryngol Head Neck Surg. 2014 Jan; 66(Suppl 1): 214–219. doi: 10.1007/s12070-011-0430-4 Castro A, Oleaga A, Parente Arias P, Paja M, Gil Carcedo E, Álvarez Escolá C. Resumen ejecutivo del documento de consenso SEORL CCC-SEEN sobre hipoparatiroidismo postiroidectomía. Endocrinol Diabetes y Nutr. 2019 Aug 1;66(7):459–63 Calvi LM, Bushinsky DA. When Is It Appropriate to Order an Ionized Calcium? J Am Soc Nephrol. 2008 Jul;19(7):1257-60. doi: 10.1681/ASN.2007121327. Epub 2008 Jan 23. Lawaetz M, Serup J, Lawaetz B, Bjoern L, Blemings A, Eklof B, et al. Comparison of endovenous ablation techniques, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Extended 5-year follow-up of a RCT. Int Angiol. 2017;36(3):281–8. Tartaglia F, Giuliani A, Sgueglia M, Biancari F, Juvonen T, Campana FP. Clinical surgery Randomized study on oral administration of calcitriol to prevent symptomatic hypocalcemia after total thyroidectomy. Am J Surg. 2005 Sep;190(3):424-9. doi: 10.1016/j.amjsurg.2005.04.017 Lee JW, Kim J-K, Kwon H, Lim W, Moon B-I, Paik NS. Annals of Surgical Treatment and Research 177 Annals of Surgical Treatment and Research. Ann Surg Treat Res: Vols. 86 to 101; 2014 to 2021 https://doi.org/10.4174/astr.2019.96.4.177 Sitges-Serra A, Ruiz S, Girvent M, Manjón H, Manjón M, Dueñas JP, et al. Outcome of protracted hypoparathyroidism after total thyroidectomy. Br J Surg. 2010 Nov;97(11):1687-95. doi: 10.1002/bjs.7219 Sanabria Álvaro, Domínguez Luis C., Vega Valentín, Osorio Camilo, Duarte Daniel. Cost-effectiveness analysis regarding postoperative administration of vitamin-D and calcium after thyroidectomy to prevent hypocalcaemia. Rev. salud pública. 2011; 13( 5 ): 804-813. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0124-00642011000500009&lng=es. Pisanu A, Saba A, Coghe F, Uccheddu A. Early prediction of hypocalcemia following total thyroidectomy using combined intact parathyroid hormone and serum calcium measurement. Langenbecks Arch Surg. 2013 Mar;398(3):423-30. doi: 10.1007/s00423-012-1017-6 RA D, FT A, CR C. Hypoparathyroidism after thyroidectomy: prevention, assessment and management. Curr Opin Otolaryngol Head Neck Surg. 2017 Apr 1;25(2):142–6. Available from: https://pubmed.ncbi.nlm.nih.gov/28267706/ Lazard DS, Godiris-Petit G, Wagner I, Sarfati E, Chabolle F. Early detection of hypocalcemia after total/completion thyroidectomy: Routinely usable algorithm based on serum calcium level. World J Surg. 2012 Nov;36(11):2590–7. doi: 10.1007/s00268-012-1727-5 Bove A, Di Renzo RM, Palone G, D’Addetta V, Percario R, Panaccio P, et al. Early biomarkers of hypocalcemia following total thyroidectomy. Int J Surg. 2014 Aug 1;12:S202–4. https://doi.org/10.1016/j.ijsu.2014.05.008 Grzegory A, Pomorski L. Perioperative calcium and vitamin D supplementation in patients undergoing thyroidectomy – literature review. Polish J Surg. 2018;90(4):34–8. doi: 10.5604/01.3001.0012.0975 Del Rio, P., Rossini, M., Montana, C.M. et al. Postoperative hypocalcemia: analysis of factors influencing early hypocalcemia development following thyroid surgery. BMC Surg 18, 25 (2019). https://doi.org/10.1186/s12893-019-0483-y
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dc.format.extent.spa.fl_str_mv	41 páginas
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dc.publisher.spa.fl_str_mv	Universidad Nacional de Colombia
dc.publisher.program.spa.fl_str_mv	Bogotá - Medicina - Especialidad en Cirugía General
dc.publisher.department.spa.fl_str_mv	Departamento de Cirugía
dc.publisher.faculty.spa.fl_str_mv	Facultad de Medicina
dc.publisher.place.spa.fl_str_mv	Bogotá, Colombia
dc.publisher.branch.spa.fl_str_mv	Universidad Nacional de Colombia - Sede Bogotá
institution	Universidad Nacional de Colombia
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spelling	Atribución-NoComercial-SinDerivadas 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Zúñiga Pavia, Sergio Fabiánaf9f7a6208321b19dba41ae83000a236Gómez Gutiérrez, Carlos Andrésbc3e72d2e5d9aaedabd9778f553b73232022-03-03T21:35:21Z2022-03-03T21:35:21Z2022https://repositorio.unal.edu.co/handle/unal/81127Universidad Nacional de ColombiaRepositorio Institucional Universidad Nacional de Colombiahttps://repositorio.unal.edu.co/ilustraciones, tablasIntroducción. La hipocalcemia es la complicación más frecuente de la tiroidectomía. La profilaxis con calcio/ calcitriol es una alternativa costo-efectiva, sencilla y expedita para disminuir esta situación, sin alterar la función paratiroidea residual. Lo que no está claro es si hay superioridad de una dosis frente a otra, por lo que el objetivo de este estudio fue evaluar el comportamiento entre diferentes esquemas de profilaxis para hipocalcemia. Métodos. Estudio de cohorte retrospectivo de adultos operados en un hospital de cuarto nivel, entre febrero de 2017 y diciembre de 2020. Se calculó la tasa de síntomas, la hipocalcemia e hipercalcemia bioquímica en el control postquirúrgico durante las siguientes dos semanas. Se hizo análisis bivariado y multivariado entre dosis de calcio/ calcitriol, otros factores asociados y los desenlaces mencionados. Resultados. Se incluyeron 967 pacientes. El 10 % presentaron síntomas. No hubo diferencias significativas en el calcio sérico del control posquirúrgico entre los grupos con distintas dosis de calcio. La dosis de carbonato de calcio >3600 mg/día y el calcio en las primeras 24 horas de cirugía se asociaron a la presencia de síntomas. La dosis de calcitriol <1 mcg/día y el bocio aumentaron el riesgo de hipocalcemia bioquímica, mientras que la dosis de 1,5 mcg/día lo disminuyó. Ninguna variable evaluada se asoció a hipercalcemia bioquímica. Conclusiones: Podemos establecer que dosis altas de carbonato de calcio no se asocian menos a hipocalcemia bioquímica, lo cual está a favor de usar dosis intermedias (i.e. 3600mg/día). De forma similar, la dosis de calcitriol de 1.5mcg/día disminuye el riesgo de este desenlace. La identificación de variables que aumentan o disminuyen el riesgo de esta complicación (bocio o el calcio en las primeras 24 horas para este estudio) pueden determinar ajustes individuales en la dosis rutinaria profiláctica de calcio/calcitriol. (Texto tomado de la fuente).Introduction. Hypocalcemia is the most frequent complication of thyroidectomy. Calcium/calcitriol prophylaxis is a cost-effective, simple and expeditious alternative to reduce this situation, without altering residual parathyroid function. It is not clear whether there is superiority of one dose over another, so the objective of this study was to evaluate the behavior between prophylaxis doses for hypocalcemia. Methods. Retrospective cohort study of adults operated in a fourth level hospital, between February 2017 and December 2020. The rate of symptoms, biochemical hypocalcemia and hypercalcemia was calculated in the post surgical control during the following two weeks. Bivariate and multivariate analyses were performed between calcium/calcitriol dose, other associated factors, and the mentioned outcomes. Results. Out of the 967 patients included, 10% presented symptoms. There were no significant differences in postoperative control serum calcium between the groups with different doses of calcium. The dose of calcium carbonate > 3600 mg/day and calcium in the first 24 hours of surgery were associated with the presence of symptoms. The dose of calcitriol <1 mcg/day and goiter increased the risk of biochemical hypocalcemia, while the dose of 1.5 mcg / day decreased it. No variable evaluated was associated with biochemical hypercalcemia. Conclusions: We can establish that high doses of calcium are not less associated with biochemical hypocalcemia, which is in favor of intermediate doses (i.e. 3600mg/day). In a similar way, the calcitriol dose of 1.5mcg/day decreases the risk of this outcome. The identification of variables that increase or decrease the risk of this complication (goiter or the 24h serum calcium in this study) can decide settings in the rutinary prophylactic dose of calcium/calcitriolEspecialidades MédicasEspecialista en Cirugía General41 páginasapplication/pdfspaUniversidad Nacional de ColombiaBogotá - Medicina - Especialidad en Cirugía GeneralDepartamento de CirugíaFacultad de MedicinaBogotá, ColombiaUniversidad Nacional de Colombia - Sede Bogotá610 - Medicina y salud::617 - Cirugía, medicina regional, odontología, oftalmología, otología, audiologíaHipocalcemiaTiroidectomía/rehabilitaciónPrevención de EnfermedadesHypocalcemiaThyroidectomy/rehabilitationDisease PreventionThyroidectomyHypocalcemiaCalcium carbonateCalcitriolHypercalcemiaTiroidectomíaHipocalcemiaCarbonato de calcioCalcitriolHipercalcemiaHipocalcemia post- tiroidectomía total: análisis de dosis para suplemento rutinario profilácticoHypocalcemia following total thyroidectomy: an analysis of dose for prophylactic routinary substitutionTrabajo de grado - Especialidad Médicainfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/acceptedVersionTexthttp://purl.org/redcol/resource_type/TMBiremeChristou N, Mathonnet M. Complications after total thyroidectomy. J Visc Surg. 2013 Sep 1;150(4):249–56. https://doi.org/10.1016/j.jviscsurg.2013.04.003Orloff LA, Wiseman SM, Bernet VJ, Fahey Iii TJ, Shaha AR, Shindo ML, et al. American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults. THYROID [Internet]. 2018 [cited 2021 Aug 31];28(7). Available from: www.liebertpub.com https://doi.org/10.1089/thy.2017.0309Pãduraru DN, Ion D, Carsote M, Andronic O, Bolocan A. Post-thyroidectomy Hypocalcemia-Risk Factors and Management. Chirurgia. 2019; 114(5):564-570. doi: 10.21614/chirurgia.114.5.564Reeve 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 J Surg. 2000;24:971–5. https://doi.org/10.1007/s002680010160Lorente-Poch L, Sancho JJ, Luis Muñoz-Nova J, Sánchez-Velázquez P, Sitges-Serra A. Defining the syndromes of parathyroid failure after total thyroidectomy. Gland Surg. 2015 Feb;4(1):82-90. doi: 10.3978/j.issn.2227-684X.2014.12.04.Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, et al. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf). 2014 Jul;81 Suppl 1:1-122. doi: 10.1111/cen.12515Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg. 2014;101(4):307–20. https://doi.org/10.1002/bjs.9384Mejía, M. G., Vega, M. P., & Hakim, J. H. (2019). Prevalencia de hipocalcemia postiroidectomía en cirugía de cáncer de tiroides. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 6(2), 80–85. https://doi.org/10.53853/encr.6.2.481Sanabria, Álvaro; Gómez, X.; Domínguez, L. C.; Vega, V.; Osorio, C. Tiroidectomía Total Basada En La Evidencia, análisis De Impacto Presupuestario. Rev Colomb Cir 2012, 27, 30-39.Patel KN, Yip L, Lubitz CC, Grubbs EG, Miller BS, Shen W, et al. Executive Summary of the American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg. 2020 Mar 1;271(3):399–410. https://doi.org/10.1097/SLA.0000000000003735Xing T, Hu Y, Wang B, Zhu J. Role of oral calcium supplementation alone or with vitamin D in preventing post-thyroidectomy hypocalcaemia A meta-analysis. Medicine (Baltimore) . 2019 Feb;98(8):e14455. doi: 10.1097/MD.0000000000014455Qin Y, Sun W, Wang Z, Dong W, He L, Zhang T, et al. A Meta-Analysis of Risk Factors for Transient and Permanent Hypocalcemia After Total Thyroidectomy. Front Oncol . 2021 Feb 24;10:614089. doi: 10.3389/fonc.2020.614089. eCollection 2020.Pepe J, Colangelo • Luciano, Biamonte F, Sonato C, Danese VC, Cecchetti V, et al. Diagnosis and management of hypocalcemia. Endocrine. 2020 sep;69(3):485-495. doi: 10.1007/s12020-020-02324-2Goltzman D. Approach to Hypercalcemia. Endotext [Internet]. 2019 Oct 29 [cited 2021 Aug 31]; disponible en: https://www.ncbi.nlm.nih.gov/books/NBK279129Lukinović J, Bilić M. OveRview Of ThyROid SuRgeRy COmpliCATiOnS. Acta Clin Croat. 2020 Jun; 59(Suppl 1): 81–86. doi: 10.20471/acc.2020.59.s1.10Cho, J. N., Park, W. S., & Min, S. Y. (2016). Predictors and risk factors of hypoparathyroidism after total thyroidectomy. International journal of surgery (London, England), 34, 47–52. https://doi.org/10.1016/j.ijsu.2016.08.019Al-Dhahri SF, Mubasher M, Al-Muhawas F, Alessa M, Terkawi RS, Terkawi AS. Early Prediction of Oral Calcium and Vitamin D Requirements in Post-thyroidectomy Hypocalcaemia. Otolaryngol Head Neck Surg. 2014 Sep;151(3):407-14. doi: 10.1177/0194599814536848Huguet I. Postoperative thyroid hypocalcemia diagnosis and management protocol. Rev Osteoporos Metab Miner. 2020; 12 (2): 71-76. DOI: 10.4321/S1889-836X2020000200006Vijay Nemade S, Vasant Rokade V, Aniruddha Pathak N, Sushil Tiwari S, Jayant Sonkhedkar S. Comparison Between Perioperative Treatment with Calcium and with Calcium and Vitamin D in Prevention of Post Thyroidectomy Hypocalcemia. Indian J Otolaryngol Head Neck Surg. 2014 Jan; 66(Suppl 1): 214–219. doi: 10.1007/s12070-011-0430-4Castro A, Oleaga A, Parente Arias P, Paja M, Gil Carcedo E, Álvarez Escolá C. Resumen ejecutivo del documento de consenso SEORL CCC-SEEN sobre hipoparatiroidismo postiroidectomía. Endocrinol Diabetes y Nutr. 2019 Aug 1;66(7):459–63Calvi LM, Bushinsky DA. When Is It Appropriate to Order an Ionized Calcium? J Am Soc Nephrol. 2008 Jul;19(7):1257-60. doi: 10.1681/ASN.2007121327. Epub 2008 Jan 23.Lawaetz M, Serup J, Lawaetz B, Bjoern L, Blemings A, Eklof B, et al. Comparison of endovenous ablation techniques, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Extended 5-year follow-up of a RCT. 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BMC Surg 18, 25 (2019). https://doi.org/10.1186/s12893-019-0483-yPúblico generalORIGINAL1019072178.2022.pdf1019072178.2022.pdfTesis de Especialidad en Cirugía Generalapplication/pdf507501https://repositorio.unal.edu.co/bitstream/unal/81127/3/1019072178.2022.pdf62e0d38ada229a02551d8c0ec000e040MD53LICENSElicense.txtlicense.txttext/plain; charset=utf-84074https://repositorio.unal.edu.co/bitstream/unal/81127/4/license.txt8153f7789df02f0a4c9e079953658ab2MD54THUMBNAIL1019072178.2022.pdf.jpg1019072178.2022.pdf.jpgGenerated Thumbnailimage/jpeg3522https://repositorio.unal.edu.co/bitstream/unal/81127/5/1019072178.2022.pdf.jpgcbdbe22225d949584dac1bc76a9cdcbdMD55unal/81127oai:repositorio.unal.edu.co:unal/811272023-08-02 23:03:38.094Repositorio Institucional Universidad Nacional de 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