Calcium, vitamin D or recombinant parathyroid hormone for managing post-thyroidectomy hypoparathyroidism

Edafe, Ovie; Mech, Claudia E; Balasubramanian, Sabapathy P

doi:10.1002/14651858.cd012845.pub2

Cited by 24 publications

(33 citation statements)

References 67 publications

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“…A study of 278 subjects found a percent of 27.3% positive for hypocalcemia and 15.1% for hypoparathyroidism (21). Based on this trial, the hypocalcemia differs with age, sex (females seems to have a higher risk), it is more frequent if lymph node dissection is associated to thyroid remove, it differs with type of thyroidectomy (as expected, larger dissections have a higher risk; also the intervention for recurrent goiter and second intervention for post-operatory bleeding increase the risk of hypocalcemia) and the duration of procedure and also if the PTH is low or lownormal pre-operatory the post-operative hypocalcemia is more frequent (21,22).…”

Section: General Datamentioning

confidence: 91%

“…The most common risk factors of hypocalcemia after thyroidectomy have been widely analyzed (21,22). A study of 278 subjects found a percent of 27.3% positive for hypocalcemia and 15.1% for hypoparathyroidism (21).…”

Section: General Datamentioning

confidence: 99%

Section: General Datamentioning

confidence: 99%

“…Low levels of pre-operatory calcium, 25hydrroxivitamin D and PTH also might be predictive for their post-operatory values (22). However, the routine pre-operatory PTH or screening of 25-hydroxivitamin D as the best tool of vitamin D metabolism is not typically recommended for every thyroid condition with normal baseline calcium levels (22). The only exception is related to medullary thyroid cancer which requires a screening for MEN (Multiple Endocrine Neoplasia) type 2 meaning checking for primary hyperparathyroidism and also for a pheocromocytoma in association to calcitonin assays (30,31).…”

Section: General Datamentioning

confidence: 99%

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Post-thyroidectomy Hypocalcemia - Risk Factors and Management

Păduraru¹,

Ion²,

Cârșote³

et al. 2019

chr

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Section: General Datamentioning

confidence: 91%

Section: General Datamentioning

confidence: 99%

Section: General Datamentioning

confidence: 99%

Section: General Datamentioning

confidence: 99%

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Post-thyroidectomy Hypocalcemia - Risk Factors and Management

Păduraru¹,

Ion²,

Cârșote³

et al. 2019

chr

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“…None of our patients developed hypercalcemia as a complication of supplemental treatment, 28 nor hematoma, permanent recurrent laryngeal nerve injury, or hypoparathyroidism as a complication of TT. 2,4,22,29e33 Vitamin D deficiency is considered a potential risk factor of postoperative hypoparathyroidism, and preoperative vitamin D supplementary treatment is preferable.…”

Section: Discussionmentioning

confidence: 63%

The Optimal Parathyroid Hormone Cut-Off Threshold for Early and Safe Management of Hypocalcemia After Total Thyroidectomy

Bashir

Alzubaidi²,

Bashir³

et al. 2021

Endocrine Practice

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Objective: To define optimal intact parathyroid hormone (iPTH) cut-off threshold predictive of hypocalcemia after total thyroidectomy for safe and effective postoperative management. Methods: This prospective single center study was done in 2 phases. In phase I, predictors of symptomatic hypocalcemia were analyzed and the receiver operating characteristic curve was used to define the optimal iPTH cut-off threshold predictive of hypocalcemia. Phase II studied giving prompt prophylactic supplemental calcium and vitamin D to all patients who had iPTH levels below the calculated threshold, while phase I patients were given prompt selective supplementation if they had postoperative hypocalcemia or symptoms. Results: Univariate analysis of patients in phase I showed that postoperative iPTH was the only significant variable that can predict symptomatic hypocalcemia. Using receiver operating characteristic curve and Youden index, the confirmed optimal cut-off threshold predictive of hypocalcemia was iPTH 19.95 pg/mL, with area under the curve of 0.903, 100% sensitivity, negative predictive value, and highest Youden index, while iPTH 15 pg/mL and iPTH 10 pg/mL were less optimal. Symptomatic hypocalcemia occurred in 30% of the phase I cohort who received selective supplementation versus 3% of those in the phase II cohort who received prophylactic supplementation. Return to emergency department and need for intravenous calcium were also significantly better in phase II. Conclusion: iPTH cut-off for post-thyroidectomy hypocalcemia was 19.95 pg/mL. Low-risk patients were discharged with no supplementation while all high-risk patients received prompt calcium and vitamin D supplementation, which led to effective hypocalcemia management and safe 24-hour discharge.

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