Abstract
Post-thyroidectomy hypocalcemia is a frequent and variable complication in Saudi Arabia, which can extend hospital stays and raise healthcare costs. A systematic search was performed using databases for studies published before January 2024 documenting hypocalcemia rates in Saudi Arabian adults following thyroidectomy. Eighteen studies met our criteria, encompassing 3,455 patients. The analyses revealed substantial variability across included studies in terms of sample size, design, and reported hypocalcemia rates. Overall rates ranged from 0.07% to 67.4% (averaging 24.4%), with transient cases being more prevalent (averaging 26.8%). Permanent hypocalcemia rates were lower (averaging 1.3%, ranging from 0 to 3.7%). Preoperative and postoperative parathyroid hormone levels consistently predicted hypocalcemia. Additional potential contributing factors included the number of parathyroid glands identified during surgery, gender, pre-surgical hyperthyroidism, and surgical expertise and experience. These findings translate to several implications for surgical practice and patient management. Close monitoring of parathyroid hormone levels holds significant importance. Selective identification of parathyroid glands during surgery might decrease the risk of hypoparathyroidism. Additionally, surgeon training and supervision are pivotal for achieving optimal outcomes. Identifying patients at risk for hypocalcemia early might facilitate earlier discharge. In conclusion, post-thyroidectomy hypocalcemia poses a variable and widespread complication in Saudi Arabia. Comprehending its risk factors and implementing targeted strategies have the potential to improve patient management and outcomes

Key words: Hypocalcemia, hypoparathyroidism, thyroidectomy, Saudi, complication