Determinación de paratirina en suero como factor predictivo de hipocalcemia tras tiroidectomía total

Alonso, Manuel Díez; López, José Daniel Sánchez; Peña, María Isabel Sánchez-Seco; Jiménez, Tomás R.; Gómez, Inmaculada; Pascual, Ángel Rodríguez; Martín‐Duce, Antonio; Hidalgo, Gregorio Guadalix; Domínguez, Sara Hernández; Vicent, Javier Granell

doi:10.1016/j.ciresp.2008.09.006

Cited by 15 publications

(2 citation statements)

References 24 publications

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“…In a multicenter study with 1157 patients, Hallgrimsson et al found that patients who experienced a 2–3% decrease in post-operative Ca in the 24 h following surgery, in comparison with the pre-operative level of Ca, had a 94% chance of developing temporary hypocalcemia [ 25 ]. Changes in the levels of Ca in the blood during the first 24 h following surgery allow prediction of temporary hypocalcemia with 19–91% sensitivity [ 26 – 30 ]. A blood Ca concentration of 1.88 mmol/L or less during the first 24 h after surgery has been associated with permanent hypocalcemia [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors of postoperative hypocalcemia occurring after a total thyroidectomy: results of prospective multicenter study

et al. 2018

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BackgroundThyroid surgeries are among the most common operations performed in the world. Hypocalcemia following total thyroidectomy is a common complication that is sometimes difficult to correct. The aim of this study is to determine the risk factors for hypocalcemia following total thyroidectomy and their clinical value.MethodsFrom January 2015 through to April 2017, 400 patients were included in this prospective multicenter study. All patients underwent total thyroidectomy due to various thyroid diseases. The following risk factors were analyzed: pre-operative and post-operative biochemical blood parameters, clinical effects and factors related to surgery, the patient, and the disease.ResultsPost-operative hypocalcemia developed in 257 patients (64.2%). Of them, 197 patients (76.7%) were diagnosed with asymptomatic hypocalcemia. Clinical symptoms were present in 60 of the 257 patients with hypocalcemia (23.3%). The statistically significant predictors of hypocalcemia were decreased calcium and ionized calcium pre-operatively (p < 0.001), parathyroid hormone on day one following surgery (p < 0.001), thyrotoxicosis <10 years before surgery (odds ratio 1.65, 95% CI 1.01–2.70, p = 0.046), the number of parathyroid glands found during surgery (odds ratio 0.52, 95% CI 0.38–0.70, p < 0.001), ligation of the trunk of the left inferior thyroid artery (odds ratio 2.04, 95% CI 1.27–3.29, p = 0.003), ligation of the trunk of the right inferior thyroid artery (odds ratio 2.37, 95% CI 1.47–3.81, p < 0.001), and the number of transplanted parathyroid glands (odds ratio 1.87, 95% CI 1.12–2.97, p = 0.015). In the multivariate analysis, age (odds ratio 1.05, 95% CI 1.01–1.09, p = 0.029) and gender (odds ratio 5.94, 95% CI 1.13–31.26, p = 0.035) were statistically significant predictors.ConclusionsThis study demonstrates that there is a number of different patient (gender, age, and duration of thyrotoxicosis <10 years before surgery) and surgical (number of parathyroid glands found during surgery, decreased calcium and ionized calcium before surgery, parathyroid hormone on day one following surgery, and ligation of the trunk of the left and right inferior thyroid artery) risk factors predictive of hypocalcemia following total thyroidectomy. Optimization of the surgical technique could possibly prevent the occurrence of hypocalcemia after total thyroidectomy in some cases; in other cases, identification of known risk factors post-operatively could permit early detection and effective treatment of these patients.

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Section: Discussionmentioning

confidence: 99%

Predictors of postoperative hypocalcemia occurring after a total thyroidectomy: results of prospective multicenter study

et al. 2018

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“…Postoperative serial serum Ca measurements might be used to predict post-thyroidectomy hypocalcemia. In two studies, ionized calcium levels of 0.95 mmol/l or lower, or total serum calcium concentrations lower than 7.5 mg/dl on the first postoperative day were significantly associated with transient symptomatic hypocalcemia (25,26). However, postoperative serum Ca concentration may not be reliable for the early prediction of hypocalcemia because change in serum Ca concentrations do not manifest during the first postoperative 24 hours (12).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Postoperative Percent Change of Parathormone Level From Baseline Value on the Rate of Hypocalcemia After Total Thyroidectomy

Sormaz

İşcan

Özgür

et al. 2017

International Surgery

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Background: To investigate the impact of the percent change of postoperative parathormone (PoPTH) level from baseline value (∆PTH) on the rate of hypocalcemia after total thyroidectomy. Methods: Assays of serum PTH and calcium (Ca) were performed preoperatively and at 24 hours postoperatively in 222 consecutive patients who underwent total thyroidectomy. Postoperative hypocalcemia was defined as serum calcium level corrected for albumin concentration (cCa) <8.5mg/dl. Patients with postoperative hypocalcemia were classified as group1 (n=100) and those with normal Ca levels as group 2 (n=122). The PoPTH levels and ∆PTH were compared between the two groups. ROC analysis was performed to determine the cut off values for PoPTH and ∆PTH. Results: The mean PoPTH level was significantly lower in group 1 compared to group 2 (18.6±15.3 pg/ml vs 32.3±15.6 pg/ml, respectively; P<0.0001). PoPTH values were within normal range in 54% of the patients with hypocalcemia and 35% of those with symptomatic hypocalcemia. PoPTH <28pg/ml or ∆PTH >45 were significantly associated with increased risk of post-thyroidectomy hypocalcemia (P=0.0001). A ∆PTH >70% ,PoPTH ≤ 15.5pg/ml and postoperative serum cCa concentrations<8.0mg/dl significantly predicted symptomatic hypocalcemia(P=0.009;P=0.006;andP=0.0001;respevtively).The sensitivities of ∆PTH,PoPTH level and postoperative serum cCa concentration to predict symptomatic hypocalcemia were 67%,64% and100, respectively. Conclusion: Although, PTH decline significantly correlate with symptomatic hypocalcemia, a considerable number of patients may experience hypocalcemic

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Association of Parathyroid Hormone Level With Postthyroidectomy Hypocalcemia

et al. 2018

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The existing literature regarding PTH levels to predict postthyroidectomy hypocalcemia is extremely heterogeneous. A single PTH threshold is not a reliable measure of hypocalcemia. Additional prospective studies controlled for timing of laboratory draws and a priori defined PTH thresholds need to be performed to ascertain the true prognostic significance of PTH in predicting postthyroidectomy hypocalcaemia.

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Determinación de paratirina en suero como factor predictivo de hipocalcemia tras tiroidectomía total

Cited by 15 publications

References 24 publications

Predictors of postoperative hypocalcemia occurring after a total thyroidectomy: results of prospective multicenter study

Predictors of postoperative hypocalcemia occurring after a total thyroidectomy: results of prospective multicenter study

The Impact of Postoperative Percent Change of Parathormone Level From Baseline Value on the Rate of Hypocalcemia After Total Thyroidectomy

Association of Parathyroid Hormone Level With Postthyroidectomy Hypocalcemia

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