Next-day Parathyroid Hormone as a Predictor of Post-thyroidectomy Hypocalcemia

Paul, Mazhuvanchary Jacob; Paul, Thomas; Abraham, Deepak Thomas; Cherian, Anish Jacob

doi:10.5005/jp-journals-10002-1192

Cited by 4 publications

(3 citation statements)

References 30 publications

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“…Other published studies have proposed cutoffs between 6 and 15 pg/mL but these studies differed in study design, population studied, the definition of hypocalcemia, the technique of PTH measurement, the protocol of calcium/calcitriol supplementation of calcium/calcitriol, and possibly some undetermined factors. 2,11,13,18,25,26 A prospective study having a patient population and methodology similar to ours reported a cutoff of PTH measured on the morning of the first postoperative day to be 6 pg/mL. 18 The definition of hypocalcemia used in this study was a serum albumin-corrected calcium <8.0 mg/dL, and no differentiation was made between patients having biochemical or clinical hypocalcemia.…”

Section: Discussionmentioning

confidence: 71%

“…2,11,13,18,25,26 A prospective study having a patient population and methodology similar to ours reported a cutoff of PTH measured on the morning of the first postoperative day to be 6 pg/mL. 18 The definition of hypocalcemia used in this study was a serum albumin-corrected calcium <8.0 mg/dL, and no differentiation was made between patients having biochemical or clinical hypocalcemia. Additionally, the protocol of calcium/calcitriol supplementation was not specified.…”

Section: Discussionmentioning

confidence: 71%

“…The risk of hematoma is negligible after 24 h, hence in our setting second postoperative day following TT could be the ideal timing of discharge if the risk of CH can be confidently ruled out. 17,18…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of Serum Parathyroid Hormone Measured on the Early Morning of the First Postoperative Day in Predicting Clinically Significant Post-Total Thyroidectomy Hypocalcemia

Singh

Sahoo

Sinha

et al. 2023

The American Surgeon™

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Introduction Clinical hypocalcemia (CH) following total thyroidectomy (TT) is a potentially life-threatening condition if left untreated. This study aimed at evaluating the accuracy of parathyroid hormone (PTH) measured in the early morning of the first postoperative day (POD-1) in predicting CH, and determining the cutoff values of PTH that can predict the development of CH. Methods We performed a retrospective review of patients undergoing TT between February 2018 and July 2022. Serum PTH, calcium, and albumin levels were measured on morning (6-8 AM) of postoperative day one (POD-1), and serum calcium level was measured from POD-2 onwards. We performed ROC curve analysis to determine the accuracy of PTH in predicting postoperative CH, and cutoff values of PTH to predict CH. Results Ninety-one patients, 52 (57.1%) with benign and 39 (42.9%) with malignant goiter were included. The incidence of biochemical, and clinical hypocalcemia was 24.2% and 30.8%, respectively. In our study serum, PTH measured in the early morning of first postoperative day following TT was found to have good accuracy (AUC = .88) in predicting CH. A PTH value of ≥27.15 pg/mL was found to have a 96.4% sensitivity in ruling out CH, while a serum PTH value <10.65 pg/mL had a specificity of 95.2% in predicting CH. Discussion Patients with a serum PTH value of ≥27.15 pg/mL can be discharged without any supplements, those with PTH <10.65 pg/mL should be started on calcium and calcitriol supplements, while patients having PTH values between 10.65 and 27.15 pg/mL should be monitored for the development of signs and/or symptoms of hypocalcemia.

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