Course of Ionized Calcium After Thyroidectomy

Sousa, Alexandre de Andrade; Salles, José Maria Porcaro; Soares, João Marcos Arantes; Moraes, Gustavo Meyer de; Carvalho, Jomar Rezende; Rocha, Paulo Roberto Savassi

doi:10.1007/s00268-010-0415-6

Cited by 24 publications

(12 citation statements)

References 26 publications

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“…Two patients with a PTH 24h of 10-15 ng/L did not develop hypocalcemia (so-called false positives); such patients have also been previously reported [18,24]. Surprisingly, up to 34 % of the non-Graves' disease patients with a QiPTH 15 C15 ng/L developed transient hypocalcemia (so-called false negatives); this high rate is close to the 40.8 % reported by de Andrade Sousa et al [25]. Actually, the PTH level declined 15 % from baseline in non-Graves' disease patients with a QiPTH 15 C15 ng/L, and even 3 % of our patients with a normal PTH level after a hemithyroidectomy developed transient hypocalcemia (data not shown).…”

Section: Discussionsupporting

confidence: 81%

Do We Overtreat Post‐Thyroidectomy Hypocalcemia?

Huang

2012

World j. surg.

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Background Calcium and calcitriol supplements are standard for patients with post-thyroidectomy serum calcium \2.0 mmol/L; however, we wondered whether we overtreat post-thyroidectomy hypocalcemia with intraoperative parathyroid hormone (PTH). We examined quick-intraoperative intact PTH (QiPTH) assay results to find a suitable treatment for post-thyroidectomy hypocalcemia. Methods We studied 197 bilateral thyroidectomy patients. Post-thyroidectomy hypocalcemia was defined as serum calcium \2.0 mmol/L. A QiPTH assay was done 15 min after the thyroidectomy (QiPTH 15 ), and hypoparathyroidism was defined as PTH\15 ng/L. The QiPTH 15 assay was used to determine the effects of the thyroidectomy on postoperative PTH levels and serum calcium levels. The natural course and medical response of hypocalcemia was observed in patients with a QiPTH 15 C15 ng/L. Results None of the 187 patients with a QiPTH 15 C15 ng/L developed postoperative hypoparathyroidism. However, 79 patients developed transient hypocalcemia, and those with Graves' disease (47/94) had significantly (p \ 0.05) higher hypocalcemia than those with non-Graves' thyroid disease (32/93). The serum calcium of these 79 patients declined to its lowest level within the first postoperative 18 h. Seven patients with serum calcium \1.75 mmol/L were successfully treated using a calcium supplement only, and the others recovered spontaneously without treatment. Conclusions When post-thyroidectomy QiPTH 15 was C15 ng/L, postoperative hypoparathyroidism was excluded, but more than one-third of the patients developed post-thyroidectomy hypocalcemia. However, most of them recovered without treatment, and a few recovered after taking only a calcium supplement. We believe that using QiPTH 15 results as a guide will prevent overtreatment of post-thyroidectomy hypocalcemia.

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Section: Discussionsupporting

confidence: 81%

Do We Overtreat Post‐Thyroidectomy Hypocalcemia?

Huang

2012

World j. surg.

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“…Determination of serum calcium and/or the PTH levels at day 1 to discriminate the patients who are truly at risk of hypocalcaemia [12, 13]. This stance avoids unnecessary treatment of patients that will ultimately not develop hypoPTH (24 patients [9%] in our study), but it exposes (at the onset of symptoms) the patients that will really develop hypoPTH (31 patients [12%] in our study).…”

Section: Discussionmentioning

confidence: 99%

Parathyroid Hormone Assays following Total Thyroidectomy: Is There a Predictive Value?

Galy-Bernadoy¹,

Lallemant²,

Chambon³

et al. 2017

Eur Thyroid J

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Objectives: Parathyroid hormone (PTH) is a risk marker for hypoparathyroidism (hypoPTH). This study aimed to determine the predictive values of early PTH assays carried out at the moment of skin closure (PTH SC), to establish a treatment algorithm, identifying two threshold values. We assessed the reproducibility of this approach with two different immunoassay kits (hypoPTH) after total thyroidectomy, but its practical application is not consensual. Study Design: We conducted a prospective descriptive study, including all patients who underwent a total thyroidectomy between March 2012 and November 2013. Postoperative PTH SC levels, corrected calcium on postoperative days, and occurrence of hypoPTH symptoms were collected. Results: Of 257 patients, the rate of hypoPTH was 20%. Threshold values to obtain a 100% positive predictive value to identify patients for whom hypoPTH was absolutely certain were: PTH SC <7 ng/L for the Roche kit and PTH SC <4 ng/L for the Beckman-Coulter kit. Threshold values to obtain a 100% negative predictive value to identify patients for whom the absence of hypoPTH was absolutely certain were: PTH SC ≥19 ng/L for the Roche kit and PTH SC ≥9 ng/L the Beckman-Coulter kit. Conclusions: A single serum PTH sampled at skin closure is a reliable test to predict hypoPTH after a total thyroidectomy. The use of a threshold based on a 100% negative predictive value enables patients with no risk of hypoPTH to be safely discharged within the first 24 h postoperatively without unnecessary calcium and vitamin treatment. This medication can be given promptly to patients at risk of hypoPTH to limit the occurrence of hypocalcaemia.

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“…Lim et al (20) consider intact PTH level one hour after surgery to be a sensitive predictor of the risk of developing postoperative symptomatic hypocalcemia. According to other authors, sufficient indication is provided by ionized calcium levels on postoperative days 1 and 2 (21). Given the difficulties involved in identifying factors increasing the risk of hypocalcemia after thyroidectomy, other authors have suggested routinely issuing discharged patients with a prescription for continuous oral calcium, with or without oral vitamin D (22).…”

Section: Discussionmentioning

confidence: 99%

Is ionized calcium a reliable predictor of hypocalcemia after total thyroidectomy? A before and after study

Tartaglia

Giuliani

Sgueglia

et al. 2014

gchir

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Hypocalcemia may be the only complication precluding a short postoperative hospital stay after total thyroidectomy (1, 2). Much has been written in the literature about the possibility of identifying (using different methods and predictors) which thyroidectomy patients will develop symptomatic hypocalcemia and which will not. Some authors (3-6) consider early postoperative (24-hour) serum calcium levels and intraoperative identification of parathyroid glands to be important predictive factors. Others (7-9) have instead suggested combining intact parathyroid hormone (PTH) and serum calcium measurements, arguing that PTH and serum calcium monitoring after the first postoperative hour would allow reliable prediction of postoperative hypocalcemia. Some authors (10-12) recommend quick PTH assay as a means of predicting postoperative parathyroid function, although others (13) found no overall significant difference in the capacity of intraoperative PTH levels, versus early postoperative serum calcium levels (day 1), to predict long-term hypoparathyroidism. In an attempt to identify reliable predictors of post-operative hypocalcemia, we measured ionized calcium levels before and after surgery and compared the data gathered with total serum calcium levels and symptoms of hypocalcemia (paresthesias and Chvostek's sign). The aim of the present study was to determine whether ionized calcium concentration is a better predictor of post-thyroidectomy hypocalcemia than total serum calcium.

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Course of Ionized Calcium After Thyroidectomy

Abstract: Measurement of ionized calcium on postoperative days 1 and 2 is sufficient for the evaluation of post-thyroidectomy hypocalcemia. Ionized calcium concentrations <1.03 mmol/l on postoperative day 1 are indicative of the presence of symptoms and the need for treatment.

Cited by 24 publications

References 26 publications

Do We Overtreat Post‐Thyroidectomy Hypocalcemia?

Do We Overtreat Post‐Thyroidectomy Hypocalcemia?

Parathyroid Hormone Assays following Total Thyroidectomy: Is There a Predictive Value?

Is ionized calcium a reliable predictor of hypocalcemia after total thyroidectomy? A before and after study

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