Comparison of Intraoperative versus Postoperative Parathyroid Hormone Levels to Predict Hypocalcemia Earlier after Total Thyroidectomy

Lee, David R; Hinson, Andrew M.; Siegel, Eric R.; Steelman, Susan; Bodenner, Donald; Stack, Brendan C.

doi:10.1177/0194599815596341

Cited by 45 publications

(37 citation statements)

References 30 publications

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“…Postoperative PTH serum levels may accurately predict occurrence as well as severity of hypocalcaemia after thyroidectomy . Numerous studies have utilized either absolute values or relative percentage decrease of PTH for diagnosis .…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative PTH serum levels may accurately predict occurrence as well as severity of hypocalcaemia after thyroidectomy. [17][18][19][20][21][22][23][24][25][26] Numerous studies have utilized either absolute values or relative percentage decrease of PTH for diagnosis. 20,[27][28][29][30][31][32] In addition, timing for PTH measurements varies significantly among studies, ranging from intraoperative measurements to measurements in the early postoperative period (generally 1-4 hours after surgery) up to 24 hours postoperatively.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy

et al. 2018

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“…The half-life of PTH is 3 minutes and its measurement is a very accurate predictor of subsequent hypocalcemia (30). It appears to be no disadvantage using intraoperative PTH measurement versus that obtained postoperatively to guide initial clinical management of serum calcium (31). In our study, PTH following surgery differed significantly between the two groups of patients.…”

Section: Discussionmentioning

confidence: 53%

Identification of Patients at High Risk for Postsurgical Hypoparathyroidism

Kakava

Tournis

Makris

et al. 2020

In Vivo

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Background/Aim: Postsurgical hypoparathyroidism (PostHypo) is a common complication after total thyroidectomy. We studied the risk factors associated with PostHypo. Patients and Methods: The study included 109 women, (mean age: 50.7±10.75 years), who underwent total thyroidectomy for thyroid diseases. Results: Based on the development of biochemical hypocalcemia on the first postoperative day following total thyroidectomy, (cCa<8.4 mg/dl), 37 women developed PostHypo and 72 did not. Younger age, a lower preoperative corrected calcium and the presence of parathyroid glands in the specimens were related to the development of PostHypo. Of all patients, 51.4% had a vitamin D deficiency. A parathyroid hormone (PTH) value ≤9.4 pg/ml was 84.9% sensitive and 71.4% specific to predict PostHypo on the 1 st postoperative day. A 50% reduction of the PTH value on the 1 st postoperative day from the preoperative level could identify patients who develop PostHypo with 76% sensitivity and 75% specificity. Conclusion: PTH postoperative measurement and its alteration from the preoperative level can be used to identify patients who are at increased risk to develop PostHypo.

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“…In the review of Grodski and Serpell,14 it was concluded that PTH measurement varies from 10 minutes postoperatively to several hours, which would provide equally accurate results. Lee et al15 concluded in a meta-analysis that intraoperative PTH has no significant advantage over early postoperative PTH when used as a clinical guide for discharge after thyroidectomy. In our study, PTH, measured in the next morning after surgery, presented an excellent predicting and discriminative ability.…”

Section: Discussionmentioning

confidence: 99%

Protocol for management after thyroidectomy: a retrospective study based on one-center experience

Luo

Yang

Wei

et al. 2017

TCRM

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Background and aimThe optimal approach to detect and treat symptomatic hypocalcemia (SxH) after thyroidectomy is still uncertain. In our retrospective study, we sought to set a standardized postoperative management protocol on the basis of relative change of parathyroid hormone (PTH) and absolute value of postoperative day 1 (POD1) PTH.MethodsPatients who underwent thyroidectomy were identified retrospectively in our prospective database. Blood was collected 1 day before surgery and on POD1. Extra calcium and calcitriol supplement was prescribed when necessary. Meanwhile, postoperative signs of SxH were treated and recorded in detail. Patients were followed up for 1 month after surgery and then 3 months thereafter.ResultsA total of 744 patients were included in the final analysis. Transient SxH occurred in 86 (11.6%) patients, and persistent SxH occurred in 4 (0.54%) patients in more than half year after surgery. Relative decrease of PTH reached its maximal discriminative effect at 70% (area under the curve [AUC] =0.754), with a sensitivity of 72.1% and a specificity of 75%. In Group 1 (≤70%), 24 (4.67%) patients were interpreted as having SxH, whereas in Group 2, 62 (27.0%) patients had SxH (>70%), P<0.001. Days of symptom relief in Group 1–1 (1, 2) were significantly shorter than those in Group 2–2 (1, 10), P=0.023. In Group 2, 112 (80%) patients with POD1 PTH <1 pmol/L were treated with calcitriol, whereas only 8 (8.89%) patients with POD1 PTH ≥1 pmol/L were treated with calcitriol (P<0.001). According to relief of SxH and recovery of parathyroid function, treating with and without calcitriol showed no difference in patients with POD1 PTH <1 and ≥1 pmol/L.ConclusionRelative decrease of PTH >70% is a significant risk factor for SxH in post-thyroidectomy. The decreasing percent of PTH ≤70% ensures discharge on POD1, but longer hospitalization was advocated for patients with decreasing percent of PTH >70%, who needed extra calcitriol supplement when POD1 PTH <1 pmol/L.

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Comparison of Intraoperative versus Postoperative Parathyroid Hormone Levels to Predict Hypocalcemia Earlier after Total Thyroidectomy

Abstract: Intraoperative PTH has no significant disadvantage versus early postoperative PTH when used as a clinical guide for discharge after thyroidectomy.

Cited by 45 publications

References 30 publications

Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy

Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy

Identification of Patients at High Risk for Postsurgical Hypoparathyroidism

Protocol for management after thyroidectomy: a retrospective study based on one-center experience

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