Hypocalcaemia after total thyroidectomy: Could intact parathyroid hormone be a predictive factor for transient postoperative hypocalcemia?

Puzziello, Alessandro; Gervasi, Rita; Orlando, Giulio; Innaro, Nadia; Vitale, Mario; Sacco, Rosario

doi:10.1016/j.surg.2014.09.004

Cited by 52 publications

(47 citation statements)

References 29 publications

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“…Postoperative PTH serum levels may accurately predict occurrence as well as severity of hypocalcaemia after thyroidectomy . Numerous studies have utilized either absolute values or relative percentage decrease of PTH for diagnosis .…”

Section: Discussionmentioning

confidence: 99%

Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy

et al. 2018

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“…F also concluded that patients with less than 80% drop in iPTH levels can be safely discharged the day of surgery [21]. Besides, Puzziello et al reported that more than 62% decreasing of iPTH in 2 h after surgery, though normocalcemia in the first day after surgery, suggested a longer hospitalization and additional therapy after discharge [22]. Furthermore, the incidence of SxH remained significantly different between groups (<70% vs >70%), even though excluded the patients with low iPTH (<1.6 pmol/L and <1 pmol/L).…”

Section: Discussionmentioning

confidence: 99%

Hypomagnesemia predicts postoperative biochemical hypocalcemia after thyroidectomy

et al. 2017

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BackgroundTo investigate the role of magnesium in biochemical and symptomatic hypocalcemia, a retrospective study was conducted.MethodsLess-than-total thyroidectomy patients were excluded from the final analysis. Identified the risk factors of biochemical and symptomatic hypocalcemia, and investigated the correlation by logistic regression and correlation test respectively.ResultsA total of 304 patients were included in the final analysis. General incidence of hypomagnesemia was 23.36%. Logistic regression showed that gender (female) (OR = 2.238, p = 0.015) and postoperative hypomagnesemia (OR = 2.010, p = 0.017) were independent risk factors for biochemical hypocalcemia. Both Pearson and partial correlation tests indicated there was indeed significant relation between calcium and magnesium. However, relative decreasing of iPTH (>70%) (6.691, p < 0.001) and hypocalcemia (2.222, p = 0.046) were identified as risk factors of symptomatic hypocalcemia. The difference remained significant even in normoparathyroidism patients.ConclusionsPostoperative hypomagnesemia was independent risk factor of biochemical hypocalcemia. Relative decline of iPTH was predominating in predicting symptomatic hypocalcemia.

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“…Puzziello et al16 stated that >62% decreasing percent of PTH in 2 hours after surgery, though normocalcemia in POD1, suggested a longer hospitalization and additional therapy after discharge, however, <62% did not. Chapman et al17 reported that patients with a >44% PTH decrease from preoperative to 6 hours postoperative are more likely to develop hypocalcemia.…”

Section: Discussionmentioning

confidence: 99%

Protocol for management after thyroidectomy: a retrospective study based on one-center experience

Luo

Yang

Wei

et al. 2017

TCRM

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Background and aimThe optimal approach to detect and treat symptomatic hypocalcemia (SxH) after thyroidectomy is still uncertain. In our retrospective study, we sought to set a standardized postoperative management protocol on the basis of relative change of parathyroid hormone (PTH) and absolute value of postoperative day 1 (POD1) PTH.MethodsPatients who underwent thyroidectomy were identified retrospectively in our prospective database. Blood was collected 1 day before surgery and on POD1. Extra calcium and calcitriol supplement was prescribed when necessary. Meanwhile, postoperative signs of SxH were treated and recorded in detail. Patients were followed up for 1 month after surgery and then 3 months thereafter.ResultsA total of 744 patients were included in the final analysis. Transient SxH occurred in 86 (11.6%) patients, and persistent SxH occurred in 4 (0.54%) patients in more than half year after surgery. Relative decrease of PTH reached its maximal discriminative effect at 70% (area under the curve [AUC] =0.754), with a sensitivity of 72.1% and a specificity of 75%. In Group 1 (≤70%), 24 (4.67%) patients were interpreted as having SxH, whereas in Group 2, 62 (27.0%) patients had SxH (>70%), P<0.001. Days of symptom relief in Group 1–1 (1, 2) were significantly shorter than those in Group 2–2 (1, 10), P=0.023. In Group 2, 112 (80%) patients with POD1 PTH <1 pmol/L were treated with calcitriol, whereas only 8 (8.89%) patients with POD1 PTH ≥1 pmol/L were treated with calcitriol (P<0.001). According to relief of SxH and recovery of parathyroid function, treating with and without calcitriol showed no difference in patients with POD1 PTH <1 and ≥1 pmol/L.ConclusionRelative decrease of PTH >70% is a significant risk factor for SxH in post-thyroidectomy. The decreasing percent of PTH ≤70% ensures discharge on POD1, but longer hospitalization was advocated for patients with decreasing percent of PTH >70%, who needed extra calcitriol supplement when POD1 PTH <1 pmol/L.

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Hypocalcaemia after total thyroidectomy: Could intact parathyroid hormone be a predictive factor for transient postoperative hypocalcemia?

Cited by 52 publications

References 29 publications

Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy

Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy

Hypomagnesemia predicts postoperative biochemical hypocalcemia after thyroidectomy

Protocol for management after thyroidectomy: a retrospective study based on one-center experience

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