Serum PTH levels as a predictive factor of hypocalcaemia after total thyroidectomy

Alonso, Manuel Díez; López, José Daniel Sánchez; Peña, María Isabel Sánchez-Seco; Jiménez, Tomás R.; Gómez, Inmaculada; Pascual, Ángel Rodríguez; Martín‐Duce, Antonio; Hidalgo, Gregorio Guadalix; Domínguez, Sara Hernández; Vicent, Javier Granell

doi:10.1016/s2173-5077(09)70122-x

Cited by 14 publications

(17 citation statements)

References 24 publications

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“…The lowest normal parathormone level was 10 pg/ml and that of calcium-2.1 mmol/l. The lowest normal level of calcium and parathormone concentrations was accepted on the basis of scientific data (1,2).…”

Section: Methodsmentioning

confidence: 99%

One-Day Thyroid Surgery – Is it Safe?

Wieloch¹,

Koza²,

Kuzdak³

et al. 2013

Polish Journal of Surgery

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the aim of the study was to evaluate the safety of one-day thyroid surgery based on the assessment of the incidence of early postoperative complications. Material and methods. The study comprised 726 patients who underwent total thyroidectomy during the period between January, 2012 and February, 2013. The study considered the three most common thyroidectomy complications. Results. In the group of 726 patients, recurrent laryngeal nerve paralysis was observed in 22 cases, accounting for 3.07% of all patients. Postoperative bleeding was observed in 12 cases (1.65%). In 8 cases, bleeding occurred during the first 8 hours after surgery, while in the remaining four cases-9, 12, 18, and 26 hours after surgery. The study group was divided into three subgroups, in which the concentrations of calcium and parathyroid hormone, 6 hours and 20 hours after surgery, were determined. In the first group (223 patients), only the parathyroid hormone level was determined. The decreased PTH level was associated with the appearance of tetany symptoms in 15% of cases. Amongst patients in whom the parathyroid hormone level was normal, tetany symptoms were observed in 0.5% of cases. In the second group (256 patients), only the serum calcium level was determined. Amongst patients with normal serum calcium levels, 1% of cases presented with tetany symptoms. In patients where the serum calcium level was reduced, tetany symptoms appeared in 35% of cases. In the third group (247 patients), both serum calcium and parathyroid hormone levels were determined. In the group of patients with normal, both serum calcium and parathyroid hormone levels, tetany symptoms were not observed. Amongst patients with normal serum calcium levels and decreased PTH levels on the day of surgery, tetany symptoms were observed in 25% of cases, while during the first postoperative day-37% of cases. Conclusion. One-day thyroid surgery, due to the appearance of complications cannot be regarded as a completely safe procedure.

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Section: Methodsmentioning

confidence: 99%

One-Day Thyroid Surgery – Is it Safe?

Wieloch¹,

Koza²,

Kuzdak³

et al. 2013

Polish Journal of Surgery

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“…[3][4][5][6][7][8][9][10][11][12][13][14][15] Furthermore, many authors have demonstrated recently the usefulness of measuring PTH early to identify patients who are at risk for developing symptomatic hypocalcemia after thyroidectomy. [15][16][17][18][19][20][21][22][23][24] However, the usefulness of measuring iPTH early to predict postoperative hypocalcemia remains controversial. Well-known risk factors for post-thyroidectomy hypocalcemia are the extent of thyroid surgery, Grave's disease, parathyroid autotransplantation, and <3 parathyroid glands identified and/or left in situ.…”

Section: Article In Pressmentioning

confidence: 99%

“…12,26,27 Recent studies have revealed that the most significant factor for predicting postoperative hypocalcemia is the decrease in serum PTH concentration that occurs 1-6 hours after thyroidectomy. [15][16][17][18][19][20][21][22][23][24] Lombardi et al 13 suggested that a single iPTH measurement taken early after thyroidectomy can predict reliably which patients are prone to clinically relevant postoperative hypocalcemia and necessitate supplementary treatment, and which patients are eligible for a safe early discharge. Lam et al 28 reported that a single PTH level of #8 pg/mL 1 hour after thyroidectomy is a strong predictor for the development of clinically significant hypocalcemia.…”

Section: Article In Pressmentioning

confidence: 99%

“…Intraoperative or early postoperative intact parathyroid hormone (iPTH) levels are reliable for predicting postoperative hypocalcemia. [15][16][17][18][19][20][21][22][23][24] Thus, an early PTH assay can facilitate early discharge, and prospectively treat symptomatic hypocalcemia. However, these studies vary widely in terms of methodology, measurement techniques, trial type, timing of measurements, protocols, and thresholds maintained.…”

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confidence: 99%

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Transient and permanent hypocalcemia after total thyroidectomy: Early predictive factors and long-term follow-up results

Seo

Chang

Jin

et al. 2015

Surgery

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“…Several studies show that low serum iPTH levels during postoperative period is a predictive factor for hypocalcemia (11,12,14,20,(26)(27)(28)(29).…”

Section: Discussionmentioning

confidence: 99%

Hypocalcemia – the most common complication after total thyroidectomy

Cmilansky¹,

L²

2014

BLL

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Abstract:Objectiva: Postoperative intact parathyroid hormone (iPTH) levels and some other factors as a predictor of hypocalcemia are analyzed in 115 patients after TTE. Background: Postoperative hypocalcemia is the most common complication observed after total thyroidectomy (TTE). It is not easy to predict in which patients this complication will occur. We adopted and implemented a novel method to predict this complication -monitoring of postoperative intact parathyroid hormone (iPTH) levels. Methods and results: Prospective study involves 115 patients. From January till December 2010 we performed 111 TTE and 4 completion thyreoidectomies (hemithyreoidectomy (HTE) after previous HTE). Gender and age of patients, fi nal histopatology diagnosis, number of parathyroid glands visible during operation, duration of operation and surgeon were factors that did not infl uence development of postoperative hypocalcemia. A hospital stay was prolonged in patients with hypocalcemia. iPTH level morning after surgery less than 15 pg/ml was a statistically signifi cant predictor of postoperative hypocalcemia. Sensitivity, specifi city, positive and negative predictive value of iPTH<15 pg/ml for predicting postoperative hypocalcemia were 71 %, 99 %, 97 % and 86 %, respectively. Sensitivity of iPTH<15 pg/ml in predicting symptomatic postoperative hypocalcemia was 100 %. Conclusion: Measuring iPTH levels morning after TTE allows prediction of subsequent hypocalcemia with a high sensitivity, specifi city, PPV and NPV. Normal iPTH levels ruled out development of hypocalcemia symptoms. Patients with normal iPTH can be safely discharged and the overtreatment of postthyroidectomy patients with calcium and/or vitamin D supplements can be also avoided (Tab. 2, Fig. 3 Acknowledgement: I would like to thank prof. MUDr. Astl J., CSc., Department of ENT, head and neck surgery, Na Homolce Hospital, Prague, Czech Republic who helped me to start with thyroid surgery. My thanks also belongs to prof. MUDr. Starek I.,CSc., ENT clinic, Faculty Hospital Olomouc, Czech Republic and Doc. MUDr. Fryšák Z., CSc., 3rd intern clinic, Faculty Hospital Olomouc, Czech Republic for critical revision and for support to organise this study.

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Serum PTH levels as a predictive factor of hypocalcaemia after total thyroidectomy

Cited by 14 publications

References 24 publications

One-Day Thyroid Surgery – Is it Safe?

One-Day Thyroid Surgery – Is it Safe?

Transient and permanent hypocalcemia after total thyroidectomy: Early predictive factors and long-term follow-up results

Hypocalcemia – the most common complication after total thyroidectomy

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