Parathyroid hormone decline 4 hours after total thyroidectomy accurately predicts hypocalcemia

Lecerf, Patrick; Orry, David; Perrodeau, Élodie; Lhommet, Claire; Charretier, Carl; Mor, Caroline; Valat, C; Bourlier, Pascal; Calan, L. De

doi:10.1016/j.surg.2012.03.011

Cited by 90 publications

(80 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The single measurement of PTH conflicted with a lack of sensitivity or specificity, depending on the threshold maintained (17,19). To resolve this threshold problem, some investigators studied the PTH decline of the perioperative periods.…”

Section: Discussionmentioning

confidence: 99%

“…To resolve this threshold problem, some investigators studied the PTH decline of the perioperative periods. 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).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2017

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

View full text Add to dashboard Cite

show abstract

“…After operation, clinical symptoms and signs such as numbness and tetany, as well as serum Ca level should be monitored. Some suggested that an early postoperative decrease in serum iPTH concentrations (8,10), combining with serum Ca concentration may predict hypoparathyroidism and guide the administration of Ca or vitamin D supplements (18,19). Post-operative hypoparathyroidism results from a reduction of functioning parathyroid parenchyma, which could be secondary to intraoperative damages caused by mechanical or thermal trauma, gland devascularization, obstruction of venous outflow, and inadvertent parathyroid excision (14,15,17).…”

Section: Risk Factors Leading To Postoperative Hypoparathyroidismmentioning

confidence: 99%

To identify or not to identify parathyroid glands during total thyroidectomy

Chang

Lang

2017

Gland Surg.

View full text Add to dashboard Cite

Hypoparathyroidism is one of the most common complications after total thyroidectomy and may impose a significant burden to both the patient and clinician. The extent of thyroid resection, surgical techniques, concomitant central neck dissection, parathyroid gland (PG) autotransplantation and inadvertent parathyroidectomy have long been some of the risk factors for postoperative hypoparathyroidism. Although routine identification of PGs has traditionally been advocated by surgeons, recent evidence has suggested that perhaps identifying fewer number of in situ PGs during surgery (i.e., selective identification) may further lower the risk of hypoparathyroidism. One explanation is that visual identification may often lead to subtle damages to the nearby blood supply of the in situ PGs and that may increase the risk of hypoparathyroidism.However, it is worth highlighting the current literature supporting either approach (i.e., routine vs. selective) remains scarce and because of the significant differences in study design, inclusions, definitions and management protocol between studies, a pooled analysis on this important but controversial topic remains an impossible task. Furthermore, it is worth nothing that identification of PGs does not equal safe preservation, as some studies demonstrated that it is not the number of PGs identified, but the number of PG preserved in situ that matters. Therefore a non-invasive, objective and reliable way to localize PGs and assess their viability intra-operatively is warranted. In this aspect, modern technology such as the indocyanine green (ICG) as near-infrared fluorescent dye for real-time in situ PG perfusion monitoring may have a potential role in the future.

show abstract

“…Though all tests had high accuracy, the addition of PTH decline to a single IOPTH level did not improve the accuracy of predicting hypocalcemia with a sensitivity of 92% and specificity of 97% for both tests. A similar study of 137 patients (14) used an interval of 4 hours and compared a single 4-hour value to the trend at 4 hours. Both the single value and the trend were highly sensitive and specific for predicting hypocalcemia with a PTH threshold of 19.4 pg/mL and a PTH decline of 69%.…”

Section: Relative Decline In Perioperative Pth Valuementioning

confidence: 99%

“…comorbidities play a minimal role (6,7,(12)(13)(14)(15). Results regarding preoperative factors including 25-OH vitamin D, serum calcium, or parathyroid hormone (PTH) levels, or indications for surgery such as Graves' disease have been variable with no clear association to the development of postoperative hypocalcemia.…”

mentioning

confidence: 99%

The role and timing of parathyroid hormone determination after total thyroidectomy

Mazotas¹,

Wang²

2017

Gland Surg.

View full text Add to dashboard Cite

Parathyroid hormone decline 4 hours after total thyroidectomy accurately predicts hypocalcemia

Cited by 90 publications

References 23 publications

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

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

To identify or not to identify parathyroid glands during total thyroidectomy

The role and timing of parathyroid hormone determination after total thyroidectomy

Contact Info

Product

Resources

About