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

Abstract

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.

Safety, Efficacy, and Cost Savings of Single Parathyroid Hormone Measurement for Risk Stratification after Total Thyroidectomy

“…In addition, postoperative hypocalcemia and its management is generally the most significant contributor to length of hospital stay after thyroid surgery. 3,4 With increasing trends toward shorter hospitalization, the ability to triage patients undergoing thyroidectomy and counsel them about their predicted length of hospital stay based on a single laboratory test has significant appeal for caregivers, patients, and hospital administrators.…”

Can Parathormon Levels after Ipsilateral Lobectomy Predict Postoperative Hypocalcemia in Patients Undergoing Total Thyroidectomy?

“…No complete consensus has been reached with studies conducted for prevention and prediction of hypocalcemia. 6,15,20,22,[33][34][35][36] This situation may be brought about by the multifactorial causes of hypocalcemia. 2,33,37,38 However, it seems that the real reason for this is the different study designs related to the topic.…”

“…6,15,20,22,[33][34][35][36] This situation may be brought about by the multifactorial causes of hypocalcemia. 2,33,37,38 However, it seems that the real reason for this is the different study designs related to the topic. 33,37,38 For example, the different timing of blood sampling for PTH measurements, the different methods used to calculate the cutoff values, and the heterogeneous operative methods (total, subtotal, complementary thyroidectomy, neck dissection) can be listed among the reasons for the different results obtained from different studies.…”

“…2,33,37,38 However, it seems that the real reason for this is the different study designs related to the topic. 33,37,38 For example, the different timing of blood sampling for PTH measurements, the different methods used to calculate the cutoff values, and the heterogeneous operative methods (total, subtotal, complementary thyroidectomy, neck dissection) can be listed among the reasons for the different results obtained from different studies. Cases of hyperthyroidism, neck dissection, subtotal thyroidectomy, complementary thyroidectomy, and recurrence were not included in our study to provide homogeneity.…”

Identification of the External Branch of the Superior Laryngeal Nerve during Thyroid Surgery

“…1,2 Protection of the laryngeal nerves (RLN and EBSLN) and preservation of vital parathyroid glands are the two main technical challenges for the operating surgeon. [1][2][3] Medical literature nowadays provides detailed description of surgical anatomy of the RLN and a relevant approach to it. Unintentional injuries associated with the above are perhaps the best known and most studied complications.…”