Background
Hypocalcemia, the most common complication of thyroidectomy, is a transient condition
in up to 27% of patients and a permanent condition approximately 1% of patients. The
aim of this prospective study was to evaluate reliability of postoperative intact
parathyroid hormone (iPTH) assessment for predicting clinically relevant postthyroidectomy
hypocalcemia for a safe early discharge of patients with no overtreatment.
Methods
Seventy-five consecutive patients (age 51 ± 13 years [mean ± SD]) undergoing total
or completion thyroidectomy with no concomitant parathyroid diseases or renal failure
were included in the present study. Serum iPTH level was determined before and 2 hours
after thyroidectomy. Serum calcium concentration was determined 1 day before and 2 days
postoperatively.
Results
The occurrence of postoperative hypocalcemia was correlated both with the absolute
and relative iPTH decrease, determined as a ratio of the preoperative value (P < .0001). There was a greater difference in relative decrease in iPTH between patients
remaining normocalcemic and those with hypocalcemia present on the second postoperative
day. Hypocalcemic patients on the second postoperative day had a 62% relative decrease
in iPTH 2 hours after thyroidectomy.
Conclusion
The relative decrease in serum iPTH was greater in patients with hypocalcemia arising
on the second postoperative day rather than in patients who remained normocalcemic.
The relative decrease in iPTH determined 2 hours after total thyroidectomy together
with the serum calcium concentration 24 hours after thyroidectomy proved to be useful
predictors of sustained hypocalcemia and might change the clinical management of patients
after thyroid surgery to support a longer hospitalization in these selected patients.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia.Br J Surg. 2014; 101: 307-320
- Surgeon's approach to the thyroid gland: surgical anatomy and the importance of technique.World J Surg. 2000; 24: 891-897
- Parathyroid preservation during thyroid surgery.Am J Otol. 1998; 19: 113-117
- Autotransplantation of at least one parathyroid gland during thyroidectomy in benign thyroid disease minimized the risk of permanent hypoparathyroidism.Zentralbl Chir. 2002; 127: 439-442
- Complication of thyroid surgery: analysis of a multicentric study on 14.934 patients operated on in Italy over 5 years.World J Surg. 2004; 28: 271-276
- Predicting calcium status post-thyroidectomy with early calcium levels.Otolaryngol Head Neck Surg. 2002; 127: 289-293
- Evaluation of total/near-total thyroidectomy in a short-stay hospitalization: safe and cost-effective.Surgery. 1995; 118: 943-947
- Hypocalcemia following thyroid surgery: incidence and prediction of outcome.World J Surg. 1998; 22: 718-724
- Low parathyroid hormone levels after thyroid surgery: a feasible predictor of hypocalcemia.Surgery. 2002; 131: 515-520
- An algorithm informed by the parathyroid hormone level reduces hypocalcemic complications of thyroidectomy.World J Surg. 2010; 34: 532-537
- Intraoperative intact parathyroid hormone level monitoring as a guide to parathyroid reimplantation after thyroidectomy.Laryngoscope. 2005; 115: 34-38
- Normalization of intraoperative parathyroid hormone does not predict normal postoperative parathyroid hormone levels.Surgery. 2000; 128: 930-935
- Hypocalcaemia and parathyroid hormone assay following total thyroidectomy: predicting the future.World J Surg. 2006; 30: 825-832
- Perioperative parathyroid hormone levels in thyroid surgery.Laryngoscope. 2006; 116: 518-521
- Parathyroid hormone as a predictor of hypocalcemia after thyroidectomy.Laryngoscope. 2005; 115: 2105-2108
- Highly sensitive two-site immune-radiometric assay of parathyrin, and its clinical utility in evaluating patients with hypercalcemia.Clin Chem. 1987; 33: 1364-1367
- Intraoperative measurement of parathyroid hormone in the surgical management of hyperparathyroidism.Surgery. 1988; 104: 1121-1127
- Rapid intraoperative immunoassay of parathyroid hormone and other hormones: a new paradigm for point-of-care testing.Clin Chem. 2004; 50: 1126-1135
- Thyroidectomy and parathyroid hormone: tracing hypocalcemia-prone patients.Am J Surg. 2008; 196: 285-288
- Serum intact parathyroid hormone as a predictor of hypocalcaemia after total thyroidectomy.ANZ J Surg. 2005; 75: 977-980
- Use of parathyroid hormone assay after thyroidectomy: a survey of US and European surgeons.Clin Med Insights Endocrinol Diabetes. 2013; 10: 39-45
- Effectiveness of an i-PTH measurement in predicting post thyroidectomy hypocalcemia: prospective controlled study.Yonsei Med J. 2013; 54: 637-642
- Identification of patients at low risk for thyroidectomy-related hypocalcemia by intraoperative quick PTH.World J Surg. 2006; 30: 1428-1433
- Parathyroid hormone: a sensitive predictor of hypocalcemia following total thyroidectomy.Otolaryngol Head Neck Surg. 2006; 134: 907-910
- Perioperative parathyroid hormone assay for diagnosis and management of post-thyroidectomy hypocalcemia.Laryngoscope. 2005; 115: 1362-1366
- Outpatient and short-stay thyroid surgery.Head Neck. 1991; 13: 97-101
- “Same-Day” thyroid surgery: an analysis of safety, cost savings, and outcome.Am Surg. 1997; 63: 586-589
- Short-stay hospitalisation for benign thyroid surgery: a prospective study.Eur Arch Otorhinolaryngol. 2013; 270: 301-304
- Timing of drainage tube removal after thyroid surgery: a retrospective study.Surg Today. 2013; 13: 531-537
- Combining early postoperative parathyroid hormone and serum calcium levels allows for an efficacious selective post-thyroidectomy supplementation treatment.World J Surg. 2012; 36: 1307-1313
- Benefits resulting from 1- and 6-hour parathyroid hormone and calcium levels after thyroidectomy.Otolaryngol Head Neck Surg. 2005; 133: 386-390
Article info
Publication history
Accepted:
September 4,
2014
Footnotes
Institution from which the work originated: General Surgery Unit, Department of Medicine and Surgery, AOU Mater Domini, University Magna Graecia, Catanzaro (Italy).
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
