Early Prediction of Hypocalcemia after Thyroidectomy using Parathyroid Hormone: An Analysis of Pooled Individual Patient Data from Nine Observational Studies

Selective Prophylactic Calcium Supplementation reduces Length of Stay after Total Thyroidectomy

“…Our measured specificity of 95.5% for a normal PTH as a predictor of normocalcemia was similar to that reported by Grodski et al 24 However, our sensitivity of 39.0% was lower. The larger proportion of patients with an undetectable PTH and, hence, higher rate of false negative results may be due to the fact that the PTH was measured immediately postoperatively, rather than at the 4 to 6 hour mark, supporting the findings of Noordzij et al, 13 who found the mean PTH of normocalcemic and hypocalcemic patients increased from immediately post thyroid gland removal to 6 hours postoperative by 25 and 27% respectively. The decision to perform the test in the recovery room rather than 4 to 6 hours after the procedure was made to maximize compliance with the introduction of a new protocol.…”

“…Predicting postoperative hypocalcemia using PTH has been extensively studied in recent years 8,[12][13][14]17,20 and various authors have attempted to ascertain the optimal time point at which to measure the PTH level. Noordzij et al 13 analyzed the pooled data from nine studies, finding that the PTH level 6 hours after surgery had the highest accuracy for predicting hypocalcemia.…”

“…Noordzij et al 13 analyzed the pooled data from nine studies, finding that the PTH level 6 hours after surgery had the highest accuracy for predicting hypocalcemia. Based on the analysis of published Australian data, [21][22][23] The Australian Endocrine Surgeons Guidelines currently recommends the routine measurement of PTH 4 hours after total thyroidectomy to guide postoperative calcium supplementation.…”

“…11 Prior to 2008, most patients at our institution remained in hospital for at least 2 days postoperatively to monitor for hypocalcemia, and supplementation was initiated, if required. In recent years, multiple studies have demonstrated that a low postoperative PTH can predict hypocalcemia; [12][13][14][15][16] however, its accuracy may be as low as 80%. 17 The halflife of PTH is approximately 2 to 3 minutes; 18 therefore, specimens sent from the recovery room should predict postoperative parathyroid status.…”

Postoperative calcium levels as a diagnostic measure for hypoparathyroidism after total thyroidectomy

“…This would allow for only those who truly need treatment to be treated and for the intensity of the replacement therapy to be individualized in each case. The "gold standard" for diagnosing hypoparathyroidism is the fast PTH assay, which measures iPO PTH, and it is the most employed method (20)(21)(22)(23). However, it is not yet available in most medical centers in Brazil.…”