Kinetics of serum parathyroid hormone during and after thyroid surgery

Hermann, Michael; Ott, Johannes; Promberger, Regina; Kober, F.; Karik, Michael; Freissmuth, Michael

doi:10.1002/bjs.6410

Cited by 85 publications

(85 citation statements)

References 64 publications

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“…7 Permanent hypoparathyroidism was a less frequent complication, with the incidence of 1.5 to 1.8%. 4,5 Permanent hypocalcaemia was absent in this study during the follow up period of one year.…”

Section: Discussionmentioning

confidence: 45%

“…1 The incidence of post-operative hypocalcaemia following total thyroidectomy ranges from 1.5% to 71% and the condition may go unnoticed if not investigated carefully. [2][3][4][5] It is often asymptomatic in the initial period. The onsets of symptom do not occur until 24-48 hours after surgery and is usually not easy to predict which patient will require oral calcium and/ or vitamin-D supplements.…”

Section: Introductionmentioning

confidence: 99%

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Early prediction of hypocalcaemia following total thyroidectomy by serial parathyroid hormone and ionized calcium assay

et al. 2016

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Section: Discussionmentioning

confidence: 45%

Section: Introductionmentioning

confidence: 99%

Early prediction of hypocalcaemia following total thyroidectomy by serial parathyroid hormone and ionized calcium assay

et al. 2016

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“…Currently available methods to evaluate parathyroid function are based on measurements of calcium16, 17 and PTH2, 6, 7, 18, 19, 20 levels at different time points after thyroidectomy. Published studies suggest that early (from a few minutes to 12 h after thyroid resection) measurement of PTH levels is a reliable tool to predict the absence of hypoparathyroidism, with a positive predictive value up to 97 per cent in some studies2, 18, 19, although this has been challenged by some authors21, 22. Unlike angiography with ICG, none of these protocols is able to predict the absence of hypoparathyroidism only a few minutes after thyroid resection.…”

Section: Discussionmentioning

confidence: 99%

Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery

Fortuny

Belfontali

Sadowski

et al. 2016

British Journal of Surgery

151

130

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BackgroundPostoperative hypoparathyroidism remains the most common complication following thyroidectomy. The aim of this pilot study was to evaluate the use of intraoperative parathyroid gland angiography in predicting normal parathyroid gland function after thyroid surgery.MethodsAngiography with the fluorescent dye indocyanine green (ICG) was performed in patients undergoing total thyroidectomy, to visualize vascularization of identified parathyroid glands.ResultsSome 36 patients underwent ICG angiography during thyroidectomy. All patients received standard calcium and vitamin D supplementation. At least one well vascularized parathyroid gland was demonstrated by ICG angiography in 30 patients. All 30 patients had parathyroid hormone (PTH) levels in the normal range on postoperative day (POD) 1 and 10, and only one patient exhibited asymptomatic hypocalcaemia on POD 1. Mean(s.d.) PTH and calcium levels in these patients were 3·3(1·4) pmol/l and 2·27(0·10) mmol/l respectively on POD 1, and 4·0(1.6) pmol/l and 2·32(0·08) mmol/l on POD 10. Two of the six patients in whom no well vascularized parathyroid gland could be demonstrated developed transient hypoparathyroidism. None of the 36 patients presented symptomatic hypocalcaemia, and none received treatment for hypoparathyroidism.Conclusion PTH levels on POD 1 were normal in all patients who had at least one well vascularized parathyroid gland demonstrated during surgery by ICG angiography, and none required treatment for hypoparathyroidism.

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“…This large range in the incidence of hypoparathyroidism in the literature is explained by the heterogeneity of its diagnosis in existing studies; only clinical or a combination of clinical and laboratory diagnostic techniques have been used. Permanent hypoparathyroidism is less frequent following total thyroidectomy, with an incidence of 1.5 to 1.8% (3,4).…”

Section: Introductionmentioning

confidence: 99%

Postoperative calcium levels as a diagnostic measure for hypoparathyroidism after total thyroidectomy

Rosa

Matos

Cernea

et al. 2015

Arch. Endocrinol. Metab.

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Objective: The aim of the present study was to identify a fast, efficient and low-cost method to diagnose hypoparathyroidism after total thyroidectomy. Materials and methods: One hundred and forty medical records, which contained patients' clinical and laboratory data, were retrospectively analyzed. Patient parathyroid hormone values, which were obtained immediately following operation, were compared with their ionized calcium levels the morning after surgery. This comparison was used to examine the correlation between the two variables in predicting hypoparathyroidism because measuring calcium levels is low-cost and more available in the hospitals compared to measuring parathormone (PTH) levels. Results: There was a positive and statistically significant correlation between PTH and ionized calcium values (Pearson correlation coefficient, r = 0.456; p < 0.0001). The values of first postoperative day ionized calcium levels (stratified by the 1.10 mmol/l cut-off value) were tested as a diagnostic measure for hypoparathyroidism, and a PTH < 15 pg/mL obtained immediately following operation served as a reference. This analysis showed that ionized calcium levels measured on the first postoperative day had a sensitivity of 45.6% (95% CI 30.9-61.0%), a specificity of 88.9% (95% CI 80.5-94.5%) and an accuracy of 76.7% (95% CI 68.7-83.5%) as a diagnostic measure for hypoparathyroidism. Conclusion: In conclusion, we demonstrated that patients who had high ionized calcium levels on the first postoperative day also had high PTH levels immediately following operation and, therefore, they had lower rates of hypoparathyroidism. Arch Endocrinol Metab. 2015;59(5):428-33

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Kinetics of serum parathyroid hormone during and after thyroid surgery

Abstract: Thyroid surgery impairs hormone secretion by the parathyroid glands resulting in postoperative latent parathyroid insufficiency. Normal PTH levels 3 h after surgery and a normal serum calcium level on the first postoperative day rule out persistent hypoparathyroidism.

Cited by 85 publications

References 64 publications

Early prediction of hypocalcaemia following total thyroidectomy by serial parathyroid hormone and ionized calcium assay

Early prediction of hypocalcaemia following total thyroidectomy by serial parathyroid hormone and ionized calcium assay

Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery

Postoperative calcium levels as a diagnostic measure for hypoparathyroidism after total thyroidectomy

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