Background
To describe a standardized, efficient, and cost-effective protocol for the diagnosis
of temporary/persisting postoperative hypoparathyroidism after (total) thyroidectomy.
Methods
We included 237 consecutive patients who underwent (total) thyroidectomy without central
neck dissection for various indications. Serum calcium (sCa) and intact parathyroid
hormone (iPTH) levels were measured prospectively on the morning of postoperative
day 1 to predict the long-term parathyroid metabolism. On the morning of postoperative
day 2, measurements were repeated. Follow-up was performed at 1 and 6 months postoperatively.
Results
On the morning of postoperative day 1, patients with iPTH ≥ 15 pg/mL (178/237; 75%)
and sCa > 2.0 mmol/L were normocalcemic, and “normal” parathyroid metabolism was predicted.
iPTH levels of <10 pg/mL and sCa levels of ≤2.0 mmol/L were present in 33 of the 237
patients (“disturbed” parathyroid metabolism; 14%). A “gray zone” included patients
with “uncertain” parathyroid metabolism demonstrating iPTH levels between 10 and 15 pg/mL
(26/237; 11%). Patients with “disturbed” and “uncertain” parathyroid metabolism were
given oral calcium and vitamin D. On the morning of the second postoperative day,
iPTH turned to “normal” in 10 of those 26 (38%) patients, and no further calcium or
vitamin D was given. During follow-up, supplemental calcium and vitamin D was able
to be stopped in all but 2 patients (“permanent” hypoparathyroidism; 2/237; 0.8%).
Conclusion
Measurement of iPTH on the morning after operation allows accurate prediction of postoperative
parathyroid function in ≥99% of cases. This simple recommendation is practicable in
all surgical units, and is an efficient and cost-effective way to recognize patients
who require calcium and vitamin D supplementation.
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Article info
Publication history
Published online: December 19, 2014
Accepted:
September 4,
2014
Footnotes
Disclosure statement: The authors have nothing to declare.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
