The role and timing of parathyroid hormone determination after total thyroidectomy

Mazotas, Ioanna G.; Wang, Tracy

doi:10.21037/gs.2017.09.06

Cited by 28 publications

(25 citation statements)

References 26 publications

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“…In patients who develop PoH following BTT, hypocalcemia is corrected by calcium and active vitamin D supplementation, which increases the length of hospital stay by an average of 8–11 days 21 , 22 . Measuring PTH levels during the postoperative 4–6 h can allow early discharge of patients at low risk of developing hypoparathyroidism and the early treatment of high-risk patients 22 . In our hospital, serum calcium and PTH levels are measured 4–6 h after thyroidectomy as per routine protocol, and thus, our patients were discharged early.…”

Section: Discussionmentioning

confidence: 99%

Risks and prediction of postoperative hypoparathyroidism due to thyroid surgery

Yazıcıoğlu

Yilmaz

Kocaöz

et al. 2021

Sci Rep

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We aimed to investigate the prevalence of postoperative hypoparathyroidism (PoH), the relevant factors, and predictors of transient or permanent hypoparathyroidism. The files of 352 patients who underwent bilateral total thyroidectomy alone or with central lymph node dissection and/or lateral neck dissection between June 1, 2019, and November 30, 2019, were retrospectively evaluated. Also, calcium and parathyroid hormone levels measured preoperatively and 4–6 h after surgery, follow-up examination results, and time to resolution of transient PoH were recorded. 16.48% (n = 58) of the surgical patients developed transient PoH and 3.98% (n = 14) developed permanent PoH. Length of hospital stay increased in patients who developed PoH (p < 0.001). Transient PoH developed less in patients who underwent parathyroid autotransplantation, while permanent PoH was not detected (p = 0.001). PoH development was not significantly correlated with nodule size as measured by preoperative thyroid ultrasonography (p = 0.944). Patients who had a serum PTH level ≤ 5.95 pmol/L 4–6 h after surgery had a greater risk of developing permanent PoH (OR 134.84, 95% CI 17.25–1053.82). PoH is more common in female gender and is not significantly correlated with nodule size. Parathyroid autotransplantation can prevent the development of PoH.

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Section: Discussionmentioning

confidence: 99%

Risks and prediction of postoperative hypoparathyroidism due to thyroid surgery

Yazıcıoğlu

Yilmaz

Kocaöz

et al. 2021

Sci Rep

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“…Highly divergent rates of post‐operative hypocalcaemia were noted based on day 1 post‐operative PTH status (Figure B), which is known to be a reliable predictor of post‐operative hypocalcaemia . To investigate for possible masking of an overall treatment effect, we performed post‐hoc analysis dichotomized by post‐operative day 1 PTH level (<10 pg/mL, below the lower limit of the local reference range; ≥10 pg/mL, normal).…”

Section: Resultsmentioning

confidence: 99%

High‐dose preoperative cholecalciferol to prevent post‐thyroidectomy hypocalcaemia: A randomized, double‐blinded placebo‐controlled trial

Rowe

Arthurs

OʼNeill

et al. 2018

Clinical Endocrinology

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Summary Objective Post‐thyroidectomy hypocalcaemia is a significant cause of morbidity and prolonged hospitalization, usually due to transient parathyroid gland damage, treated with calcium and vitamin D supplementation. We present a randomized, double‐blinded placebo‐controlled trial of preoperative loading with high‐dose cholecalciferol (300 000 IU) to reduce post‐thyroidectomy hypocalcaemia. Patients and Measurements Patients (n = 160) presenting for thyroidectomy at tertiary hospitals were randomized 1:1 to cholecalciferol (300 000 IU) or placebo 7 days prior to thyroidectomy. Ten patients withdrew prior to surgery. The primary outcome was post‐operative hypocalcaemia (corrected calcium <2.1 mmol/L in first 180 days). Results The study included 150 patients undergoing thyroidectomy for Graves’ disease (31%), malignancy (20%) and goitre (49%). Mean pre‐enrolment vitamin D was 72 ± 26 nmol/L. Postoperative hypocalcaemia occurred in 21/72 (29%) assigned to cholecalciferol and 30/78 (38%) participants assigned to placebo (P = 0.23). There were no differences in secondary end‐points between groups. In pre‐specified stratification, baseline vitamin D status did not predict hypocalcaemia, although most individuals were vitamin D replete at baseline. Post‐hoc stratification by day 1 parathyroid hormone (PTH) (<10 pg/mL, low vs ≥10 pg/mL, normal) was explored due to highly divergent rates of hypocalcaemia in these groups. Using a Cox regression model, the hazard ratio for hypocalcaemia in the cholecalciferol group was 0.56 (95%CI 0.32‐0.98, P = 0.04) after stratification for Day 1 PTH. Further clinical benefits were observed in these subgroups. Conclusions Pre‐thyroidectomy treatment with high‐dose cholecalciferol did not reduce the overall rate of hypocalcaemia following thyroidectomy. In subgroups stratified by day 1 PTH status, improved clinical outcomes were noted.

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“…To avoid the potential complications associated with reoperations, it is suggested to obtain a parathyroid hormone or serum calcium level prior to thyroid surgery. As intraoperative parathyroid hormone (ioPTH) levels are being used to obtain a baseline at the time of a total thyroidectomy and/or at the conclusion of surgery to better direct the management of potential postoperative hypoparathyroidism, an abnormally and unexpectedly high ioPTH level will raise the question of an incidental parathyroid adenoma. Incidental parathyroid adenomas that are diagnosed at the time of thyroid surgery are reported to occur in 0.2%‐4.5% of cases .…”

Section: Resultsmentioning

confidence: 99%

American Head and Neck Society Endocrine Section clinical consensus statement: North American quality statements and evidence‐based multidisciplinary workflow algorithms for the evaluation and management of thyroid nodules

et al. 2018

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Background Care for patients with thyroid nodules is complex and multidisciplinary, and research demonstrates variation in care. The objective was to develop clinical guidelines and quality metrics to reduce unwarranted variation and improve quality. Methods Multidisciplinary expert consensus and modified Delphi approach. Source documents were workflow algorithms from Kaiser Permanente Northern California and Cancer Care of Ontario based on the 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Results A consensus‐based, unified preoperative, perioperative, and postoperative workflow was developed for North American use. Twenty‐one panelists achieved consensus on 16 statements about workflow‐embedded process and outcomes metrics addressing safety, access, appropriateness, efficiency, effectiveness, and patient centeredness of care. Conclusion A panel of Canadian and United States experts achieved consensus on workflows and quality metric statements to help reduce unwarranted variation in care, improving overall quality of care for patients diagnosed with thyroid nodules.

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The role and timing of parathyroid hormone determination after total thyroidectomy

Cited by 28 publications

References 26 publications

Risks and prediction of postoperative hypoparathyroidism due to thyroid surgery

Risks and prediction of postoperative hypoparathyroidism due to thyroid surgery

High‐dose preoperative cholecalciferol to prevent post‐thyroidectomy hypocalcaemia: A randomized, double‐blinded placebo‐controlled trial

American Head and Neck Society Endocrine Section clinical consensus statement: North American quality statements and evidence‐based multidisciplinary workflow algorithms for the evaluation and management of thyroid nodules

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