Association of Parathyroid Hormone Level With Postthyroidectomy Hypocalcemia

Mathur, Aarti; Nagarajan, Neeraja; Kahan, Stacie; Schneider, Eric B.; Zeiger, Martha A.

doi:10.1001/jamasurg.2017.3398

Cited by 33 publications

(32 citation statements)

References 74 publications

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“…Most authors currently recommend routine measurement of serum calcium and parathyroid hormone (PTH) after surgery in order to predict hypocalcaemia. Patients might therefore be classified as having hypocalcaemia, with an increase in treatments and length of hospital stay, without having any symptoms.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of routine calcium/vitamin D3 supplementationversusserum calcium level-based strategy to prevent postoperative hypocalcaemia after thyroidectomy

Sanábria

Rojas

Arevalo

2019

British Journal of Surgery

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Background The aim was to assess the effectiveness of routine administration of calcium +/– vitamin D3 compared with a serum calcium level‐based strategy to prevent symptomatic hypocalcaemia after thyroidectomy. Methods RCTs comparing routine supplementation of calcium +/– vitamin D3 with treatment based on serum calcium levels measured after total thyroidectomy, published between 1980 and 2017, were identified in MEDLINE, Embase, LILACS and Google Scholar databases. Risk of bias was evaluated using the Cochrane Collaboration tool. Risk differences were calculated by random‐effects meta‐analysis. Meta‐regression and cumulative meta‐analysis were used to explore the best therapeutic approach. Results Fifteen studies with 3037 patients were included, and seven treatment comparisons were made. Routine supplementation with calcium + vitamin D3 offered a lower risk of symptomatic (risk difference (RD) –0·25, 95 per cent c.i. –0·32 to –0·18) and biochemical (RD –0·24, –0·31 to –0·17) hypocalcaemia than treatment based on measurement of calcium levels. The number needed to treat was 4 (95 per cent c.i. 3 to 6) for symptomatic hypocalcaemia. No publication bias was found; although heterogeneity was high for some comparisons, sensitivity analysis did not change the main results. Conclusion Routine postoperative administration of calcium + vitamin D3 is effective in decreasing the rate of symptomatic and biochemical hypocalcaemia.

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Section: Introductionmentioning

confidence: 99%

Meta-analysis of routine calcium/vitamin D3 supplementationversusserum calcium level-based strategy to prevent postoperative hypocalcaemia after thyroidectomy

Sanábria

Rojas

Arevalo

2019

British Journal of Surgery

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“…[18,19] We observed that most patients had a decrease in calcium during the first hours after surgery, the expected response of a parathyroid gland with a normal function would be to increase the secretion of iPTH to prevent hypocalcemia, and it may not be a false positive as previously considered. [20] This "appropriate iPTH response" is present in the patients that consequently didn't present hypocalcemia, while the patients that not only didn't increase iPTH but even decreased their concentrations, eventually presented hypocalcemia, reflecting a greater damage to the parathyroid gland and a delayed or absent response to hypocalcemia. In our study a decrease of 9.5 pg/mL or more in PTH concentrations had a good sensitivity and specificity to predict hypocalcemia, this means that patients may still have normal or detectable serum iPTH, but it is not enough to counter regulate the rapid fall in calcium.…”

Section: Discussionmentioning

confidence: 99%

Failure to Increase Parathyroid Hormone Predicts Hypocalcemia After Neck Surgery for Endocrine Diseases: A Referral Center Experience With High Risk Patients

Manuel¹,

Mendoza‐Zubieta²,

Mercado³

et al. 2019

JED

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Introduction Transitory hypoparathyroidism occurs in 16.5-71% of patients undergoing total thyroidectomy. Parathyroid hormone (PTH) rises quickly after serum calcium concentrations drop, before true hypocalcaemia ensues. We aimed to determine if this behavior is different in patients with or without hypocalcaemia after neck-surgery for endocrine diseases. Methods Total serum corrected calcium and intact PTH were determined before surgery and 6h after, calcium determined at 12h, 28h and 24h after surgery too, and compared between groups. Patients with other acute or chronic comorbidities that affect calcium metabolism were not included. Results 83 patients, 86.7% women (47% premenopausal), with a median age of 52 years were evaluated. In total, 59% had biochemical hypocalcemia, while only 28.9% were symptomatic. A decrease of iPTH of greater than 9.5pg/mL in the first 6 hours had a sensitivity of 100% and a specificity of 92.5% to predict hypocalcemia. Discussion: most patients had a decrease in calcium during the first hours after surgery, but the patients without hypocalcemia had an appropriate increase of iPTH, while the patients that developed hypocalcemia had the opposite response. Conclusion: inappropriate reductions of iPTH in the first few hours after neck surgery for endocrine diseases, may be associated with hypocalcemia during the early postoperatory days. Clinical characteristics may be insufficient to detect the patients that will benefit from prophylactic calcium supplementation in some cases.

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“…[11][12][13][14][15] The variables included a failure to reference the normal range of calcium values and the use of total, corrected or iCa. [11][12][13][14][15] The variables included a failure to reference the normal range of calcium values and the use of total, corrected or iCa.…”

Section: Discussionmentioning

confidence: 99%

“…The reported prevalence of PH after total thyroidectomy varies widely, mainly because hypocalcemia is not defined consistently. [11][12][13][14][15] The variables included a failure to reference the normal range of calcium values and the use of total, corrected or iCa. 13 Additionally, PH can be defined by biochemical blood parameters and/or by the presence of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Comparison of hypocalcemia rates between LigaSure and clamp‐and‐tie hemostatic technique in total thyroidectomies

et al. 2019

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Background Postoperative hypocalcemia (PH) is a serious complication after total thyroidectomy. This study aimed to compare PH rates between LigaSure Small Jaw (LSJ) and clamp‐and‐tie hemostatic technique in patients undergoing total thyroidectomy. Methods Four hundred twenty patients were divided into two groups: group L (210 patients) performed with LSJ and group C (210 patients) with clamp‐and‐tie technique. Serum ionized calcium (iCa) was measured before and 12, 24, 48, 72 hours after surgery. PH was defined as iCa lower than 4.2 mg/dL in at least two measurements. Results There was no significant difference between groups in sex, age, extent of surgery, pathology, and the strategy of intraoperative management of parathyroid glands (PG). The PH rate was significantly lower in group L compared to group C (22.9% vs 32.4%, P = .03). Conclusions Compared to clamp‐and‐tie technique, LigaSure is superior to decrease PH rate after total thyroidectomy.

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Association of Parathyroid Hormone Level With Postthyroidectomy Hypocalcemia

Cited by 33 publications

References 74 publications

Meta-analysis of routine calcium/vitamin D3 supplementationversusserum calcium level-based strategy to prevent postoperative hypocalcaemia after thyroidectomy

Meta-analysis of routine calcium/vitamin D3 supplementationversusserum calcium level-based strategy to prevent postoperative hypocalcaemia after thyroidectomy

Failure to Increase Parathyroid Hormone Predicts Hypocalcemia After Neck Surgery for Endocrine Diseases: A Referral Center Experience With High Risk Patients

Comparison of hypocalcemia rates between LigaSure and clamp‐and‐tie hemostatic technique in total thyroidectomies

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