Serum phosphorus values for early prediction of hypocalcemia in total thyroidectomy

Mishra, Anand; Ramakant, Pooja; Singh, Kulranjan

doi:10.21037/gs.2017.03.03

Gland Surg.

2017

DOI: 10.21037/gs.2017.03.03

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Serum phosphorus values for early prediction of hypocalcemia in total thyroidectomy

Anand Mishra

Pooja Ramakant

Kulranjan Singh

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2024

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“…14,15 Given the relationship between calcium and phosphate it has been postulated that postoperative serum phosphate level or a calcium to phosphate (Ca/P) ratio can serve as surrogates for PTH. 16,17 Hypoparathyroidism typically results in hyperphosphatemia due to increased renal phosphate absorption in the setting of low PTH. 5,14,18 Accordingly, a postoperative drop in PTH should quickly increase serum phosphate.…”

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confidence: 99%

Assessing Postoperative Phosphate and Calcium/Phosphate Ratio as Surrogates for Parathyroid Hormone Following Total Thyroidectomy

Kappauf,

Gold,

Gonzalez‐Velazquez

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveEvaluate utility of postoperative phosphate and calcium/phosphate ratio (Ca/P) as surrogates for parathyroid hormone (PTH) following total thyroidectomy.Study DesignRetrospective cohort study.SettingTertiary care hospital.MethodsWe retrospectively reviewed patients 18 years or older who underwent total thyroidectomy in a tertiary care hospital by a single surgeon from 2015 through 2021. Patients with incomplete data, pre‐existing hypoparathyroidism, vitamin D deficiency, or renal failure were excluded. All patients had PTH drawn within 4 hours of surgery and serum calcium, albumin, and phosphate levels on postoperative Day 1. Corrected calcium was used to calculate a Ca/P. Receiver operating characteristic (ROC) curves were generated to compare phosphate level or Ca/P with PTH. Each possible surrogate was assessed relative to PTH cutoffs of less than 5, 10, 15, and 20 pg/mL. A good screening test was defined as having an area under the curve (AUC) greater than 0.8.ResultsA total of 185 patients underwent total thyroidectomy with 1 fellowship‐trained otolaryngologist. Most patients were female (62%), median age 48 years. Most surgeries were performed for cancer (68%). Six (3.2%) patients required IV calcium supplementation and 2 (1.1%) required readmission for symptomatic hypocalcemia. ROC curves comparing phosphate and Ca/P to PTH at the listed cutoffs demonstrated AUC ranging from 0.55 to 0.66 and 0.61 to 0.79, respectively. None met the threshold for a good screening test.ConclusionPostoperative phosphate and Ca/P ratio are not surrogates for PTH levels following total thyroidectomy. More research is needed to identify cost‐effective strategies for postoperative calcium monitoring in patients undergoing total thyroidectomy.Level of evidenceRetrospective cohort study.

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mentioning

confidence: 99%

Assessing Postoperative Phosphate and Calcium/Phosphate Ratio as Surrogates for Parathyroid Hormone Following Total Thyroidectomy

Kappauf,

Gold,

Gonzalez‐Velazquez

et al. 2024

Otolaryngol.--head neck surg.

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Serum phosphorus values for early prediction of hypocalcemia in total thyroidectomy

Cited by 1 publication

References 3 publications

Assessing Postoperative Phosphate and Calcium/Phosphate Ratio as Surrogates for Parathyroid Hormone Following Total Thyroidectomy

Assessing Postoperative Phosphate and Calcium/Phosphate Ratio as Surrogates for Parathyroid Hormone Following Total Thyroidectomy

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