Identification of Patients at Low Risk for Thyroidectomy‐Related Hypocalcemia by Intraoperative Quick PTH

Fabio, Francesco Di; Casella, Claudio; Bugari, Giovanna; Iacobello, Carmelo; Salerni, Bruno

doi:10.1007/s00268-005-0606-8

Cited by 61 publications

(61 citation statements)

References 21 publications

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“…Almost all studies define hypocalcemia as either low serum calcium or development of symptoms of hypocalcemia (9,11,(15)(16)(17)(18)(19)(21)(22)(23)(24)(25)(26). We used only the symptoms of hypocalcemia because we believe that mixing two parameters (biochemical hypocalcemia and symptomatic hypocalcemia) can introduce a bias.…”

Section: Resultsmentioning

confidence: 99%

Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy

Vanderlei

Vieira

Hojaij

et al. 2012

Arq Bras Endocrinol Metab

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Objective: The purpose of this study was to evaluate if the measurement of peri-operative parathyroid hormone (PTH) is able to identify patients with increased risk of developing symptoms of hypocalcemia. Subjects and methods: Forty patients who underwent total thyroidectomy were studied prospectively. Ionized serum calcium and PTH were measured after induction of anesthesia, one hour (PTH1) and one day after surgery (PTH24). Patients were evaluated for symptoms of hypocalcemia and treated with calcium and vitamin D supplementation as necessary. Results: Symptomatic hypocalcemia developed in 16 patients. Symptomatic patients had significant lower PTH1 and greater drops in PTH levels. The selection of 12.1 ng/L as PTH1 level cutoff level divided patients with and without symptoms with 93.7% sensitivity and 91.6% specificity. The selection of 73.5% as the cutoff value for PTH decrease resulted in 91.6% sensitivity and 87.5% specificity. Conclusion: PTH1 levels and the drop in PTH levels are reliable predictors of developing symptomatic hypocalcemia after total thyroidectomy. Arq Bras Endocrinol Metab. 2012;56(3):168-72 Keywords Thyroid gland; PTH; hypocalcemia; thyroidectomy; parathyroid gland RESUMO Objetivo: O objetivo deste estudo é avaliar se a medida perioperatória do hormônio da paratireoide (PTH) pode identificar os pacientes com maior risco de desenvolver sintomas de hipocalcemia. Sujeitos e métodos: Foram estudados quarenta pacientes submetidos à tireo diectomia total. A medida do cálcio sérico e do PTH foi feita após a indução anestésica, uma hora (PTH1) e um dia após a cirurgia. Os pacientes foram avaliados quanto à presença de sintomas de hipocalcemia e tratados com suplementação de cálcio e vitamina D quando necessário. Resultados: Dezesseis pacientes apresentaram sintomas de hipocalcemia. Os pacientes sintomáticos apresentaram PTH1 significantemente menor e queda no PTH significativamente maior. Usando o valor de 12,1 ng/L como corte, conseguimos distinguir pacientes com e sem sintomas de hipocalcemia com sensibilidade de 93,7% e especificidade de 91,6%. Utilizando como corte a queda de 73,5% no valor do PTH, temos sensibilidade de 91,6% e especificidade de 87,5%. Conclusão: O PTH1 e a queda no PTH são bons preditores de hipocalcemia no pós-operatório de tireoidectomia total Arq Bras Endocrinol Metab. 2012;56(3):168-72

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Section: Resultsmentioning

confidence: 99%

Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy

Vanderlei

Vieira

Hojaij

et al. 2012

Arq Bras Endocrinol Metab

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“…Lecerf et al (19) indicated that the PTH decline was more precise than the PTH level alone in early diagnosis of hypocalcemia. Other several studies also have reported that percentage decline of the perioperative PTH level in the immediate postoperative period was useful to predict hypocalcemia, using the thresholds of PTH decline from 50.0% to 75.7% (20)(21)(22)(23). We demonstrated that the percentage decline of preoperative PTH level, using the cutoff value 75.0%, showed significant difference in the chance of transient hypocalcemia (P<0.001).…”

Section: Discussionmentioning

confidence: 58%

Percentage Decline of Parathyroid Hormone Level is a Predictor for Post-thyroidectomy Symptomatic Hypocalcemia

et al. 2017

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Purpose: Postoperative hypocalcemia is one of the most common complications after thyroid surgery. However, the predictive efficacy of parathyroid hormone (PTH) level was still controversial. We investigated the cut-off value of perioperative PTH level for postoperative hypocalcemia after total thyroidectomy. Methods: Four hundred eighty-two patients performed total thyroidectomy from January 2015 to December 2016 were enrolled. Demographics, operative variables and the development of symptomatic hypocalcemia were collected and evaluated. Results: Transient symptomatic hypocalcemia occurred in 83 (17.2%) patients and 5 (1.0%) patients have progressed to the permanent hypocalcemia. Patients with transient symptomatic hypocalcemia showed significantly lower postoperative day 1 PTH level than those without hypocalcemia (7.7±6.5 vs. 13.1±10.4 pg/mL; P<0.001), while correlation between postoperative PTH level and development of symptomatic hypocalcemia was not found in a multivariate analysis (P=0.122). Percentage decline of the preoperative PTH only showed significant association with transient hypocalcemia and the recommended cut-off value was 75.0%. When percentage decline of 75.0% was used, the incidence of transient hypoparathyroidism was 3.4 times (95% confidence interval, 2.1-5.6) higher in high percentage decline group (P<0.001). In regard to the permanent hypoparathyroidism, there were no significant differences in all factors. Conclusion: Percentage decline of PTH can be used as a predictive factor for postoperative hypocalcemia. Cautions against preventing injury of the parathyroid glands with careful surgical technique should be recommended.

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“…10 Similar threshold value (75.7%) is obtained by Di Fabio et al in a study of 81 patients with thyroidectomy. 12 Analysis of their results takes into account the fact that the average decrease in PTH is more pronounced after thyroidectomy (53%) compared to cases with unilateral lobectomy (20%) which is consistent with the signifi cantly lower incidence of postoperative hypoparathyroidism after partial thyroid resections. 12 The abovementioned meta-analysis of Noordzij et al states that the a decrease in PTH by 65% compared to preoperative levels measured 1 to 6 hours after thyroidectomy has a 96.45% sensitivity and 91.4% specifi city for the development of hypocalcemia.…”

Section: Hypocalcaemiamentioning

confidence: 55%

“…12 Analysis of their results takes into account the fact that the average decrease in PTH is more pronounced after thyroidectomy (53%) compared to cases with unilateral lobectomy (20%) which is consistent with the signifi cantly lower incidence of postoperative hypoparathyroidism after partial thyroid resections. 12 The abovementioned meta-analysis of Noordzij et al states that the a decrease in PTH by 65% compared to preoperative levels measured 1 to 6 hours after thyroidectomy has a 96.45% sensitivity and 91.4% specifi city for the development of hypocalcemia. 9 The different threshold levels of PTH decline provided in individual studies are most likely related to differences in the methods of PTH measurement, accepted reference ranges of calcium and the design of studies.…”

Section: Hypocalcaemiamentioning

confidence: 55%

Prognostic significance of intraoperative pth test for the development of post-thyroidectomy hypocalcaemia

Ali

2011

Folia Medica

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The high incidence of postoperative hypoparathyroidism after total thyroidectomy and the signifi cant morbidity associated with it can account for the sustained efforts to fi nd reliable, affordable markers for the prognosis of this condition. Therefore, a lot of attention has been paid recently to the perioperative measurement of the parathyroid hormone (PTH) as an immediate indicator showing the parathyroid glands functional status. There are a lot of studies in the relevant literature demonstrating that PTH is a highly sensitive marker, with high specifi city to predict development of postoperative hypocalcemia. Recent studies analyze in-depth not only the absolute values of PTH, but also the dynamics of its levels during surgery. The number and timing of sampling for testing is a matter of discussion. Importance is attached also to the hormone testing methods. Research results determine intraoperative PTH (IOPTH) as a valuable additional test for early risk assessment of hypocalcaemia allowing prevention and timely treatment of patients at risk. Early identifi cation of risk groups of patients creates a real opportunity to reduce the incidence of this complication by autotransplantation of parathyroid glands. Despite the encouraging results the predictive accuracy of this indicator is not 100%, which requires careful result interpretation. The fi ndings of researchers are not uniform, probably due to differences in study design, the methods used in PTH testing, and the accepted reference range of serum calcium. This impedes comparison of data and highlights the need for similar analyzes in each specialized center.

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Identification of Patients at Low Risk for Thyroidectomy‐Related Hypocalcemia by Intraoperative Quick PTH

Cited by 61 publications

References 21 publications

Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy

Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy

Percentage Decline of Parathyroid Hormone Level is a Predictor for Post-thyroidectomy Symptomatic Hypocalcemia

Prognostic significance of intraoperative pth test for the development of post-thyroidectomy hypocalcaemia

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