Intraoperative Parathyroid Hormone Levels in Thyroid and Parathyroid Surgery

Abstract

The study demonstrates that intraoperative PTH levels greater than 15 pg/mL after total or completion thyroidectomy indicate a low risk of postoperative hypocalcemia and that these patients may be candidates for outpatient surgery. In the parathyroid group, intraoperative PTH levels do not correlate well with postoperative calcium levels.

Intraoperative parathyroid hormone assay for management of patients undergoing total thyroidectomy

“…If patients undergoing total thyroidectomy fulfill neither of these criteria, close calcium monitoring and early supplementation of calcium/vitamin D may be needed for postoperative patients. The cutoff values to determine which patients will be safely discharged early or will need close monitoring and replacement therapy can show some differences between our study and prior reports: absolute ioPTH values at 10 pg/ mL 7,13 or 15 pg/mL 15 ; the decline percentage of ioPTH levels at 75%. 6,9 However, no previous studies have suggested such an algorithm with the combination of absolute values and decline percentage of ioPTH levels.…”

“…It has also been suggested that the rapid PTH assay might have a value in monitoring the outcome of thyroid surgery with respect to the development of postoperative hypocalcemia. 6,9,14,15 The reports asserted that the rapid PTH assay can identify patients at risk of clinically significant hypocalcemia earlier than achieved with serum calcium monitoring after thyroidectomy. In addition, intraoperative PTH levels greater than the cutoff values indicate a low risk of postoperative hypocalcemia and propose safe, early discharge.…”

“…8,16,17 However, other studies have advocated that ioPTH levels obtained immediately after thyroid dissection could be used reliably to predict postoperative hypocalcemia. 6,7,9,14,15 In addition, it was suggested that a low ioPTH level (<10 pg/mL) may be a indicator of vascular injury of an intact gland and may be a guide to more aggressive assessment of the vascularity in the parathyroid glands, and devascularized glands should be considered for autotransplantation. 10 The vascularity of parathyroid glands can be rechecked based on the ioPTH levels routinely measured at the end of thyroidectomy and evaluated by visual inspection of their vascular pedicles and small incision of the glands to access bleeding.…”

Parathyroid hormone and serum calcium levels measurements as predictors of postoperative hypocalcemia in total thyroidectomy

“…Accompanying process, for instance vitamin D insufficiency, calcitonin realizes, "hungry bone syndrome" definitely conduce to this state (2,4). Authors have analyzed simple, reliable and sensitive instruments that may predict postoperative hypocalcemia (2,(5)(6)(7)(8)(9)(10). Serial measures of parathyroid hormone (PTH)…”

Prediction of Transient and Permanent Hypoparathyroidism after Total Thyroidectomy Using the Postoperative Serum Parathyroid Hormone Test: When Is the Best Time to Check?

“…It is defined as ionized calcium (iCa) levels that remain under 1.0 mmol/L or the development of clinical symptoms and signs (2). Hypocalcemia often increases the duration of hospital stay, overall cost of a thyroidectomy, need for frequent biochemical tests, and frequency of emergency room visit (3).…”