The Impact of Postoperative Percent Change of Parathormone Level From Baseline Value on the Rate of Hypocalcemia After Total Thyroidectomy

Sormaz, İsmail Cem; İşcan, Yalın; Özgür, İlker; Karakus, Seyma; Tunca, Fatih; Şenyürek, Yasemin Giles; Terzioğlu, Tarık

doi:10.9738/intsurg-d-16-00249.1

Cited by 3 publications

(3 citation statements)

References 37 publications

(49 reference statements)

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“…In some studies to predict hypocalcemia after bilateral total thyroidectomy, some authors have found success with a single parathormone measurement [11]. As in our study, studies examining the difference between preoperative and postoperative parathormone levels also report successful results [13,14]. In a study by Noordzij et al, the percentage of PTH decline in the postoperative 6 th hour was successful in predicting postoperative hypocalcemia with a cut-off value of %65 [15].…”

Section: Discussionsupporting

confidence: 71%

Delta parathormone value as an indicator of postoperative hypocalcemia in patients with parathyroid adenoma

TOPÇU

Tutan²,

Kartal³

et al. 2023

J CLIN MED KAZ

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Aim: In primary hyperparathyroidism patients, avoiding hypoparathyroidism and hypocalcemia after surgery is essential. We aimed to evaluate if the delta parathormone percent value (ΔPTH%) can identify patients with an increased risk of developing hypocalcemia after parathyroid surgery for primary hyperparathyroidism. Material and methods: Eighty patients with parathyroid adenomas who underwent single parathyroidectomy were analyzed, and demographical data, preoperative, and postoperative laboratory data were collected were included in the study. Postoperative hypocalcemia was defined as a corrected calcium value below 8.5 mg/dL calculated from the blood values taken on the first postoperative day. The ΔPTH value was calculated by finding the difference between the preoperative PTH value and the postoperative PTH value, and the percentage of ΔPTH was calculated by dividing the ΔPTH value by the preoperative PTH (ΔPTH = Preoperative PTH – Postoperative PTH, and ΔPTH% = ΔPTH / Preoperative PTH). Results: Postoperative hypocalcemia developed in 7.5% of the patients. Hypocalcemic patients had higher ΔPTH and ΔPTH% values. The selection of 130.95 ng/L as ΔPTH level cutoff level divided patients with and without postoperative hypocalcemia with 83.3% sensitivity and 62.2% specificity. As for ΔPTH%, a cut-off value of 71.4% had 100.0% sensitivity, 56.8% specificity, and a 16-fold increase in odds of postoperative hypocalcemia. Conclusion: ΔPTH and ΔPTH% values are helpful predictors of postoperative hypocalcemia after parathyroidectomy and can be used as a guiding tool.

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Section: Discussionsupporting

confidence: 71%

Delta parathormone value as an indicator of postoperative hypocalcemia in patients with parathyroid adenoma

TOPÇU

Tutan²,

Kartal³

et al. 2023

J CLIN MED KAZ

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“…They suggested that analysis of serum Ca concentrations at 24 hours postoperatively might help to achieve a more precise prediction of patients who bear a high risk for developing hypocalcemic symptoms. [29] Sitges-Serra et al reported in a multicentric prospective study that in 91 (63%) of 145 patients with parathyroid failure (PTH <15 pg/mL at postoperative 4th hour and Ca <8 mg/dL at 24 th hour), hypocalcemia improved in 1 month, and they observed protracted hypoparathyroidism in 54 (37%) patients. They stated that 32 (22%) of these patients recovered in a year, 22 (15%) developed permanent hypoparathyroidism within 1-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

The Relationship Of Magnesium Level With The Recovery Of Parathyroid Function In Post-Thyroidectomy Hypoparathyroidism

et al. 2021

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Objectives: Hypocalcemia is the most common complication and acute parathyroid gland insufficiency is the main cause of it after thyroidectomy. In this study, we aimed to evaluate the relationship between the recovery time of parathyroid gland function and patient characteristics, preoperative and postoperative electrolyte changes, and intraoperative parathyroid findings in patients with postoperative hypoparathyroidism. Methods: Patients who underwent total thyroidectomy (TT) with or without central neck dissection ± lateral neck dissection with a parathyroid hormone (PTH) value of <15 pg/mL within the postoperative 4th hour were included in this study. Postoperative calcium level of <8mg/dL was defined as biochemical hypocalcemia and a PTH value of <15 pg/mL was defined as hypoparathyroidism. The patients were divided into three groups according to the time of PTH recovery (>15 pg/mL); within the first 24 hours, between one day and 30 days, after 30 days, respectively. Results: One hundred eleven patients (mean age, 49.3±14.4 years) consisted of Groups 1, 2 and 3, including 19 (16F, 3M), 67 (54F, 13M) and 25 (19F, 6M), respectively. Vitamin D deficiency rates for Groups 1, 2, 3 were 41.7%, 53.1% and 88.2%, respectively (p=0.018). Postoperative day 0 PTH values were 11.69±2.79pg/mL, 6.92±3.45 pg/mL, 4.99±2.36 pg/mL, (p<0.001). Biochemical hypocalcemia rates of Groups 1, 2, 3 on postoperative day 1 were 15.8%, 53.7%, 64%, (p=004) respectively, and calcium values were 8.68±0.67 mg/dL, 8.15±0.66 mg/dL, 7.75±1 mg/dL, (p=0.014), respectively. Magnesium values on postoperative day 1 and 7 for Groups 1, 2, 3 were 1.85±0.1 mg/dL, 1.77±0.17 mg/dL, 1.64±0.17 mg/dL, (p=0.005), and 1.86±0.16mg/dL, 1.82±0.21mg/dL, 1.59±0.15mg/dL (p=0.001), respectively. PTH values on postoperative day 1 and 7 in Groups 1, 2, 3 were 20.5±6.4 pg/mL, 7.06±4.35 pg/mL, 4.66±3.26 pg/mL (p<0.001), and 31.04±10.54pg/mL, 18.72±13.84pg/mL, 4.55±4.9pg/mL (p<0.0001), respectively. Parathyroid function improved in 106 patients, and permanent hypoparathyroidism developed in five patients (4.5%). Conclusion:Hypoparathyroidism can recover rapidly in the first 24 hours in patients with a PTH value of around 10 pg/mL at postoperative 4th hour. As the number of preserved parathyroids increased, recovery time decreased. In patients with postoperative hypoparathyroidism, postoperative low magnesium levels may be associated with delayed recovery of parathyroid function.

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“…L. Shifrin, 2021). Sormaz et al, (2021) reported that patients with normal calcium values and PTH values above 28.0 pg/ml six hours after the operation had a very low risk of developing hypocalcemia (Sormaz et al, 2021).…”

Section: Hyperparathyroidismmentioning

confidence: 99%

Post-thyroidectomy hypocalcemia and related complications

Al-Roubaie

2022

ijhs

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The incidence of post-thyroidectomy hypocalcemia is high while the factors involved include age (> 50 years), type of operation, operative time, neck dissection, histology of the surgical specimen and vocal fold paralysis. Low ionic calcium concentrations are indicative of the presence of symptoms of hypocalcemia and the need for oral calcium. Progression to definitive hypoparathyroidism occurs only in patients with clinical manifestations of post-thyroidectomy hypocalcemia. In general, the problem with post-surgical hypoparathyroidism resides in the surgical procedure itself. The most common are related to neuronal hyperexcitability, which explains the paresthesias, cramps and numbness, which usually start in the perioral region and on the fingertips. Muscle spasms and muscle stiffness are also common. When severe, hypocalcemia can lead to life-threatening spastic tetany, laryngospasm, and seizures. The current manuscript aimed to present a review of the bibliography on thyroidectomy and negative impact of its complications on human health, mainly because of a higher risk for developing hypocalcemia. To achieve the study goal, this review covered most recent published articles from 2017 onward.

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The Impact of Postoperative Percent Change of Parathormone Level From Baseline Value on the Rate of Hypocalcemia After Total Thyroidectomy

Cited by 3 publications

References 37 publications

Delta parathormone value as an indicator of postoperative hypocalcemia in patients with parathyroid adenoma

Delta parathormone value as an indicator of postoperative hypocalcemia in patients with parathyroid adenoma

The Relationship Of Magnesium Level With The Recovery Of Parathyroid Function In Post-Thyroidectomy Hypoparathyroidism

Post-thyroidectomy hypocalcemia and related complications

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