The Timing of Calcium Measurements in Helping to Predict Temporary and Permanent Hypocalcaemia in Patients Having Completion and Total Thyroidectomies

Pfleiderer, A; Ahmad, Nader; Draper, Mark; Vrotsou, Kalliopi; Smith, Wendy K.

doi:10.1308/003588409x359349

Cited by 79 publications

(86 citation statements)

References 24 publications

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“…First of all, the definition of hypocalcemic symptom is subjective and arbitrary, and many previous studies have used their own definitions (13,(24)(25)(26)(27)(28)(29). The result of this study may be biased by the threshold for pain or tingling sensation of the patients.…”

Section: Discussionmentioning

confidence: 99%

Percentage Decline of Parathyroid Hormone Level is a Predictor for Post-thyroidectomy Symptomatic Hypocalcemia

et al. 2017

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Purpose: Postoperative hypocalcemia is one of the most common complications after thyroid surgery. However, the predictive efficacy of parathyroid hormone (PTH) level was still controversial. We investigated the cut-off value of perioperative PTH level for postoperative hypocalcemia after total thyroidectomy. Methods: Four hundred eighty-two patients performed total thyroidectomy from January 2015 to December 2016 were enrolled. Demographics, operative variables and the development of symptomatic hypocalcemia were collected and evaluated. Results: Transient symptomatic hypocalcemia occurred in 83 (17.2%) patients and 5 (1.0%) patients have progressed to the permanent hypocalcemia. Patients with transient symptomatic hypocalcemia showed significantly lower postoperative day 1 PTH level than those without hypocalcemia (7.7±6.5 vs. 13.1±10.4 pg/mL; P<0.001), while correlation between postoperative PTH level and development of symptomatic hypocalcemia was not found in a multivariate analysis (P=0.122). Percentage decline of the preoperative PTH only showed significant association with transient hypocalcemia and the recommended cut-off value was 75.0%. When percentage decline of 75.0% was used, the incidence of transient hypoparathyroidism was 3.4 times (95% confidence interval, 2.1-5.6) higher in high percentage decline group (P<0.001). In regard to the permanent hypoparathyroidism, there were no significant differences in all factors. Conclusion: Percentage decline of PTH can be used as a predictive factor for postoperative hypocalcemia. Cautions against preventing injury of the parathyroid glands with careful surgical technique should be recommended.

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Section: Discussionmentioning

confidence: 99%

Percentage Decline of Parathyroid Hormone Level is a Predictor for Post-thyroidectomy Symptomatic Hypocalcemia

et al. 2017

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“…RLS zedelenmesi özellikle bilateral olduğunda glottik yetmezliğe yol açtığından ciddi sorun yaratır. Tek taraflı paralizili olgular %30-50 oranında asemptomatik seyredebilmektedir (8,9). Kalıcı RLS hasarı total tiroidektomide yaklaşık %1-1,5'tir.…”

Section: Discussionunclassified

Tiroid Cerrahisi Deneyimlerimiz

Tutar

Bakkal

Aydíl

et al. 2013

GMJ

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ÖZETAmaç: Tiroid bezi cerrahisi yaptığımız olguları değerlendirmek ve deneyimlerimizi sunmak. Yöntem: Gazi Üniversitesi Tıp Fakültesi kulak boğaz burun kliniğinde 2008 ile 2012 yılları arasında tiroidektomi yapılan 68 hasta çalışmaya alındı. Hastaların demografik özellikleri, patolojik tanıları, uygulanan cerrahi yöntemler, komplikasyonlar ve postoperatif klinik izlemleri retrospektif olarak kaydedildi. Bulgular: Hastaların 63'ü primer, 5'i revizyon hastadır. Hastaların 37 (%54) tanesi malign patoloji nedeniyle opere edilmiştir. En sık karşılaşılan patoloji papiller karsinom (%44) daha sonra nodüler guatrdır (%32). Tüm hastalarda sinir monitörü rutin olarak uygulanmıştır. En sık uygulanan cerrahi yöntem total tiroidektomidir (%76). Eş zamanlı olarak 21 hastaya boyun diseksiyonu (%31), 1 hastaya mediastinal diseksiyon uygulanmıştır. Laringeal invazyon nedeniyle 2 hastaya total larenjektomi, senkron adenom varlığı nedeniyle 1 hastaya da eş zamanlı paratiroidektomi yapılmıştır. İlk operasyonda boyun diseksiyonu yapılmayan 3 (%4) primer hastamıza, takiplerinde boyunda lenf nodu metastazı nedeniyle, boyun diseksiyonu yapılmıştır. Postoperatif dönemde en sık geçici hipokalsemi (%15) görülmüştür. Hiçbir hastada operasyona sekonder vokal kord paralizisi izlenmemiştir. Sonuç: Tiroid patolojisi nedeniyle operasyonu planlanan hastaların preoperatif değerlendirmesi önemlidir. Operasyon sırasında sinir monitörünün kullanılması rekürren laringeal sinir hasarını önemli ölçüde azaltır. Klinik şüphe varlığında boyun diseksiyonunun primer cerrahi sırasında uygulanması ile boyun metastazları önemli ölçüde azaltılır. Results: Of the patients 63 were primary and 5 were revision patients. Thirtyseven patients (54%) were operated for malignant pathology. The most common pathology was papillary carcinoma (44%) then nodular goiter (32%) was seen. Nerve monitor was routinely used in all operations. The most common surgical method is total thyroidectomy (76%). Of the 37 malignant patients 21 had concurrent neck dissection (57%) and one had mediastinal dissection. Total laryngectomy was performed for 2 patients due to laryngeal invasion and concurrent parathyroidectomy was performed for 1 patient due to synchronous parathyroid adenoma. Neck dissection was performed to 3 primary patients (8%) due to lymph node metastasis to the neck. Transient hypocalcemia (15%) was the most common complication in the postoperative period. None of the patients had vocal cord paralysis secondary to the surgery. Conclusion: Preoperative evaluation of patients with thyroid pathology is important. Recurrent laryngeal nerve injury could be decreased by the usage of nerve monitor routinely when neck dissection. As the presence of clinical suspicion, performing concurrent neck dissection with thyroidectomy may decrease the neck metastasis during follow-up significantly.

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“…Pflederer et al reported a prospective cohort involving 162 patients who underwent total or completion thyroidectomy (33). Association test between number of PGs identified and the development of hypocalcemia produced a significant result in post-operative 6 months (Chi =11.4, P=0.022).…”

Section: Permanent Hypocalcemiamentioning

confidence: 99%

“…When no PGs were seen, 70% had normo-calcemia and 30% has temporary hypocalcemia. For those with all PGs identified, 90% developed temporary hypocalcemia and 10% with permanent hypocalcemia, which required exogenous Ca and vitamin D beyond 6 months after operation (33). Similarly, a recently published prospective study by Lang et al with 569 patients who underwent total thyroidectomy for benign disease reported that permanent hypocalcemia, which was defined as requiring exogenous Ca or vitamin D one year after operation, was significantly higher in patient with 4 PGs identified than in patients with 0-1 PGs identified (11.2% vs. 1.5%, P<0.001).…”

Section: Permanent Hypocalcemiamentioning

confidence: 99%

To identify or not to identify parathyroid glands during total thyroidectomy

Chang

Lang

2017

Gland Surg.

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Hypoparathyroidism is one of the most common complications after total thyroidectomy and may impose a significant burden to both the patient and clinician. The extent of thyroid resection, surgical techniques, concomitant central neck dissection, parathyroid gland (PG) autotransplantation and inadvertent parathyroidectomy have long been some of the risk factors for postoperative hypoparathyroidism. Although routine identification of PGs has traditionally been advocated by surgeons, recent evidence has suggested that perhaps identifying fewer number of in situ PGs during surgery (i.e., selective identification) may further lower the risk of hypoparathyroidism. One explanation is that visual identification may often lead to subtle damages to the nearby blood supply of the in situ PGs and that may increase the risk of hypoparathyroidism.However, it is worth highlighting the current literature supporting either approach (i.e., routine vs. selective) remains scarce and because of the significant differences in study design, inclusions, definitions and management protocol between studies, a pooled analysis on this important but controversial topic remains an impossible task. Furthermore, it is worth nothing that identification of PGs does not equal safe preservation, as some studies demonstrated that it is not the number of PGs identified, but the number of PG preserved in situ that matters. Therefore a non-invasive, objective and reliable way to localize PGs and assess their viability intra-operatively is warranted. In this aspect, modern technology such as the indocyanine green (ICG) as near-infrared fluorescent dye for real-time in situ PG perfusion monitoring may have a potential role in the future.

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The Timing of Calcium Measurements in Helping to Predict Temporary and Permanent Hypocalcaemia in Patients Having Completion and Total Thyroidectomies

Cited by 79 publications

References 24 publications

Percentage Decline of Parathyroid Hormone Level is a Predictor for Post-thyroidectomy Symptomatic Hypocalcemia

Percentage Decline of Parathyroid Hormone Level is a Predictor for Post-thyroidectomy Symptomatic Hypocalcemia

Tiroid Cerrahisi Deneyimlerimiz

To identify or not to identify parathyroid glands during total thyroidectomy

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