Early prediction of hypocalcemia after thyroidectomy by parathormone measurement in surgical site irrigation fluid

Kamer, Erdinç; Ünalp, Haluk Recai; Erbil, Yeşim; Akgüner, Taner; İşsever, Halim; Tarcan, Ercüment

doi:10.1016/j.ijsu.2009.07.006

Cited by 18 publications

(15 citation statements)

References 37 publications

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“…There is no definitive evidence on the impact of age on the development of post-operative hypocalcemia in the literature. Some studies suggest that temporary post-operative hypocalcemia is more common in younger patients [ 15 , 25 ], while others suggest it is more common in older patients [ 19 , 21 ]. A meta-analysis of five studies with 2576 patients revealed no significant association between patient age and temporary hypocalcemia [ 15 , 17 – 19 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some studies suggest that temporary post-operative hypocalcemia is more common in younger patients [ 15 , 25 ], while others suggest it is more common in older patients [ 19 , 21 ]. A meta-analysis of five studies with 2576 patients revealed no significant association between patient age and temporary hypocalcemia [ 15 , 17 – 19 , 21 ]. While a meta-analysis of 10 studies involving 3443 patients showed that temporary post-operative hypocalcemia was more common in women [ 12 , 15 , 17 – 21 , 23 , 41 , 51 ].…”

Section: Discussionmentioning

confidence: 99%

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Predictors of postoperative hypocalcemia occurring after a total thyroidectomy: results of prospective multicenter study

et al. 2018

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BackgroundThyroid surgeries are among the most common operations performed in the world. Hypocalcemia following total thyroidectomy is a common complication that is sometimes difficult to correct. The aim of this study is to determine the risk factors for hypocalcemia following total thyroidectomy and their clinical value.MethodsFrom January 2015 through to April 2017, 400 patients were included in this prospective multicenter study. All patients underwent total thyroidectomy due to various thyroid diseases. The following risk factors were analyzed: pre-operative and post-operative biochemical blood parameters, clinical effects and factors related to surgery, the patient, and the disease.ResultsPost-operative hypocalcemia developed in 257 patients (64.2%). Of them, 197 patients (76.7%) were diagnosed with asymptomatic hypocalcemia. Clinical symptoms were present in 60 of the 257 patients with hypocalcemia (23.3%). The statistically significant predictors of hypocalcemia were decreased calcium and ionized calcium pre-operatively (p < 0.001), parathyroid hormone on day one following surgery (p < 0.001), thyrotoxicosis <10 years before surgery (odds ratio 1.65, 95% CI 1.01–2.70, p = 0.046), the number of parathyroid glands found during surgery (odds ratio 0.52, 95% CI 0.38–0.70, p < 0.001), ligation of the trunk of the left inferior thyroid artery (odds ratio 2.04, 95% CI 1.27–3.29, p = 0.003), ligation of the trunk of the right inferior thyroid artery (odds ratio 2.37, 95% CI 1.47–3.81, p < 0.001), and the number of transplanted parathyroid glands (odds ratio 1.87, 95% CI 1.12–2.97, p = 0.015). In the multivariate analysis, age (odds ratio 1.05, 95% CI 1.01–1.09, p = 0.029) and gender (odds ratio 5.94, 95% CI 1.13–31.26, p = 0.035) were statistically significant predictors.ConclusionsThis study demonstrates that there is a number of different patient (gender, age, and duration of thyrotoxicosis <10 years before surgery) and surgical (number of parathyroid glands found during surgery, decreased calcium and ionized calcium before surgery, parathyroid hormone on day one following surgery, and ligation of the trunk of the left and right inferior thyroid artery) risk factors predictive of hypocalcemia following total thyroidectomy. Optimization of the surgical technique could possibly prevent the occurrence of hypocalcemia after total thyroidectomy in some cases; in other cases, identification of known risk factors post-operatively could permit early detection and effective treatment of these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of postoperative hypocalcemia occurring after a total thyroidectomy: results of prospective multicenter study

et al. 2018

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“…In some studies, advanced age group [18], and in other studies younger age group [11] were found to be at risk. In a review of 2576 patients performed by Edafe et al, no difference in development of hypocalcemia based on age [19].…”

Section: Discussionmentioning

confidence: 99%

Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy

Özemir

Buldanlı

Yener

et al. 2016

North Clin Istanbul

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OBJECTIVE:The present study evaluated effects of incidental parathyroidectomy, surgical technique, and presence of thyroiditis or hyperthyroidism on occurrence of postoperative persistent or transient hypocalcemia.METHODS:Patients who underwent thyroidectomy at İstanbul Medeniyet University between 2013 and 2015 were included in the study. Patient information, postoperative serum calcium levels, and pathology reports were investigated retrospectively. Group 1 was made up of patients who were found to have hypocalcemia (calcium ≤8.5 mg/dL) according to postoperative serum level and normocalcemic patients were placed in Group 2. Groups were compared statistically in terms of rate of incidental parathyroidectomy, surgical technique, and presence of thyroiditis or hyperthyroidism.RESULTS:Mean age was 49.8±12.8 years (range: 20-88). A total of 417 patients were included in the study, 74 (17.7%) were male and 343 (82.3%) were female. Group 1 consisted of 205 (49.2%) patients who had hypocalcemia according to postoperative serum level, and remaining 212 (50.8%) patients were placed in Group 2. In Group 1, 38 (18.5%) patients had incidental parathyroidectomy, and with only 18 (8.5%) patients in Group 2, a statistically significant relationship was found between incidental parathyroidectomy and hypocalcemia (p=0.003). There was no statistically significant difference in terms of presence of thyroiditis or hyperthyroidism between groups. There was statistically significant decrease in postoperative hypocalcemia rate in patients with lobectomy compared to patients with bilateral total thyroidectomy or central neck dissection (p<0.01).CONCLUSION:Risk of postoperative hypocalcemia may be reduced with lobectomy for selected patients. In addition, delicate dissection during thyroidectomy is important in order to protect parathyroid glands and prevent hypocalcemia.

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“…A small number of studies have found hypocalcemia to be associated with advanced age, 15,23–25 whereas others have reported an association with younger age. 26–28 A recent meta-analysis by Edafe et al 20 evaluated age as a predictor of hypocalcemia in 2576 patients and found no significant difference in mean age between patients with hypocalcemia and those without.…”

Section: Discussionmentioning

confidence: 96%

Early Predictors of Hypocalcemia After Total Thyroidectomy

Noureldine

Genther

Lopez

et al. 2014

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Postoperative hypocalcemia is common after total thyroidectomy, and perioperative monitoring of serum calcium levels is arguably the primary reason for overnight hospitalization. Confidently predicting which patients will not develop significant hypocalcemia may allow for a safe earlier discharge. OBJECTIVE To examine associations of patient characteristics with hypocalcemia, duration of hospitalization, and postoperative intact parathyroid hormone (IPTH) level after total thyroidectomy. DESIGN, SETTING, AND PARTICIPANTS Retrospective study of consecutive patients who underwent total thyroidectomy by a single high-volume surgeon between February 1, 2010, and November 30, 2012. Postoperative serum 25-hydroxyvitamin D (vitamin D), calcium, and IPTH levels were tested within 6 to 8 hours after surgery. Mild hypocalcemia was defined as any postoperative serum calcium level of less than 8.4 to 8.0 mg/dL. Significant hypocalcemia was defined as any postoperative serum calcium level of less than 8.0 mg/dL or the development of hypocalcemia-related symptoms. INTERVENTIONS Total thyroidectomy. MAIN OUTCOMES AND MEASURES Associations of patient demographic and clinical characteristics and laboratory values with postoperative mild and significant hypocalcemia were examined using univariate analysis, and independent predictors of hypocalcemia, duration of hospitalization, and IPTH level were determined using multivariate analysis. RESULTS Overall, 304 total thyroidectomies were performed. Mild and significant hypocalcemia occurred in 68 (22.4%) and 91 (29.9%) patients, respectively, of which the majority were female (P = .003). The development of significant hypocalcemia was associated with postoperative IPTH level (P < .001). On multivariate analysis, males had a decreased risk of developing mild (odds ratio, 0.37 [95% CI, 0.16–0.85]) and significant (odds ratio, 0.57 [95% CI, 0.09–0.78]) hypocalcemia. Every 10-pg/mL increase in postoperative IPTH level predicted a 43% decreased risk of significant hypocalcemia (P < .001) and an 18% decreased risk of hospitalization beyond 24 hours (P = .03). Presence of malignant neoplasm carried a 27% risk of mild hypocalcemia (P = .02). There was a progressively increasing risk of lower IPTH levels for each parathyroid gland inadvertently resected or autotransplanted. Male sex and African American race were independently predictive of higher IPTH levels. CONCLUSIONS AND RELEVANCE Low postoperative IPTH level, female sex, and presence of malignant neoplasm are all significant, independent predictors of hypocalcemia after total thyroidectomy. Clinicians should consider these variables when deciding how to best manage or prevent postoperative hypocalcemia.

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Early prediction of hypocalcemia after thyroidectomy by parathormone measurement in surgical site irrigation fluid

Abstract: High irPTH level is significantly associated with postoperative hypocalcemia. The irPTH assay is sufficient to identify hypocalcemia in the majority of patients and it is a sensitive tool to identify patients at risk of developing postoperative hypocalcemia.

Cited by 18 publications

References 37 publications

Predictors of postoperative hypocalcemia occurring after a total thyroidectomy: results of prospective multicenter study

Predictors of postoperative hypocalcemia occurring after a total thyroidectomy: results of prospective multicenter study

Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy

Early Predictors of Hypocalcemia After Total Thyroidectomy

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