To investigate the histopathological features of pathologic parathyroid specimens associated with negative preoperative technetium Tc 99m sestamibi scans.
this study was to develop a more inclusive cutoff point (PTH Ͻϭ15ng/L) which would allow for early supplementation for the majority of patients. METHODS: This retrospective study involved 114 consecutive thyroidectomy patients (October 2004-2005). PTH and calcium levels, length of admission, supplementation and rates of hypocalcemia were recorded. RESULTS: Some 39% (11/28) of patients developing hypocalcemia met the current PTH Ͻϭ8ng/L cutoff. In contrast, 71% (20/28) of patients developing hypocalcemia met the new PTH cutoff of Ͻϭ15ng/L. Only one out of 114 patients had a one-hour PTH Ͻϭ15ng/L and failed to develop hypocalcemia. The 32% (9/28) of patients meeting the new cutoff, but not the old one, could have been discharged sooner (24 vs. 66.5 hours, pϽ0.01) with earlier supplementation. CONCLUSIONS: A new 1-hr PTH cutoff of Ͻϭ15ng/L for prophylactic supplementation could significantly alter the current protocol for post-thyroidectomy patients, and should allow the prevention of the majority of cases of hypocalcemia, leading to shorter stays and more savings. A prospective study and a new management algorithm are necessary to confirm these findings.
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