A Single Parathyroid Hormone Level Obtained 4 Hours after Total Thyroidectomy Predicts the Need for Postoperative Calcium Supplementation

Carr, Azadeh A.; Fareau, Gilbert G.; Cayo, Ashley K.; Misustin, Sarah M.; Evans, Douglas B.; Wang, Tracy

doi:10.1016/j.jamcollsurg.2014.06.003

Cited by 55 publications

(52 citation statements)

References 23 publications

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“…Measuring the serum PTH immediately after surgery is a sensitive and specific method of assessing the function of the parathyroid glands and for identifying patients at risk for hypocalcemia [1–4]. If the postoperative PTH level is low, then administering calcium and activated vitamin D (calcitriol) can reduce the incidence of symptomatic hypocalcemia [5–10]. …”

Section: Introductionmentioning

confidence: 99%

Hypoparathyroidism after total thyroidectomy: incidence and resolution

Ritter

Elfenbein

Schneider

et al. 2015

Journal of Surgical Research

154

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Background Parathyroid hormone (PTH) levels are often measured after thyroid surgery and are used to detect patients at risk for postoperative hypoparathyroidism. However, there is a lack of consensus in the literature about how to define the recovery of parathyroid gland function and when to classify hypoparathyroidism as permanent. The goals of this study were to determine the incidence of low postoperative PTH in total thyroidectomy patients and to monitor their time course to recovery of parathyroid gland function. Methods We identified 1054 consecutive patients who underwent a total or completion thyroidectomy from 1/2006 to 12/2013. Low PTH was defined as a PTH measurement <10 pg/mL immediately after surgery. Patients were considered to be permanently hypoparathyroid if they had not recovered within 1 year. Recovery of parathyroid gland function was defined as PTH ≥10 pg/mL and no need for therapeutic calcium or activated vitamin D (calcitriol) supplementation to prevent hypocalcemic symptoms. Results Of 1054 total thyroidectomy patients, 189 (18%) had a postoperative PTH <10 pg/mL. Of those 189 patients, 132 (70%) showed resolution within 2 months of surgery. Notably, 9 (5%) resolved between 6–12 months. At 1 year, 20 (1.9%) were considered to have permanent hypoparathyroidism. Surprisingly, 50% of those patients had recovery of PTH levels yet still required supplementation to avoid symptoms. Conclusions Most patients with a low postoperative PTH recover function quickly, but it can take up to 1 year for full resolution. Hypoparathyroidism needs to be defined not only by PTH levels, but also by medication requirements.

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Section: Introductionmentioning

confidence: 99%

Hypoparathyroidism after total thyroidectomy: incidence and resolution

Ritter

Elfenbein

Schneider

et al. 2015

Journal of Surgical Research

154

View full text Add to dashboard Cite

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“…Conversely postoperative hypocalcemia may also occur after 48-72 hours after surgery, and is the most common cause of prolonged hospitalization after thyroid surgery (15,58). Transient hypocalcemia may occur in 25% of patients undergoing bilateral thyroid surgery and is permanent in 0.9-14% of cases (59,60). So, predicting which patients will be affected by hypocalcemic complication within the first 24 hours, is critical for planning an early discharge.…”

Section: Discussionmentioning

confidence: 99%

Early discharge after total thyroidectomy: a retrospective feasibility study

Tartaglia

Giuliani

Sorrenti

et al. 2016

Gchir

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“…Decreased absolute values of iPTH within the first day postoperatively at 4hours < 10 pg/mL [49,50] or at 24 hours < 5.8 pg/mL, are correlated with postoperative hypocalcemia [12,24]. Accordingly, levels > 7 pg/mL [20], > 9.8 pg/mL [12], > 15 pg/mL [24,28,47], could exclude the development of persistent hypoparathyroidism.…”

Section: Post-surgical Hypoparathyroidism In Thyroid Surgerymentioning

confidence: 99%