Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurement

Lombardi, Celestino Pio; Raffaelli, Marco; Princi, Pietro; Santini, Stefano Angelo; Boscherini, Mauro; Crea, Carmela De; Traini, Emanuela; D'Amore, Annamaria; Carrozza, Cinzia; Zuppi, Cecilia; Bellantone, Rocco Domenico Alfonso

doi:10.1016/j.surg.2004.06.053

Cited by 184 publications

(195 citation statements)

References 14 publications

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“…demonstrated that 64% of those patients who subsequently required calcium supplementation had a decrease in PTH levels greater than 75% from baseline 20 minutes after surgery, and 74% of those who did not need calcium supplementation demonstrated a decrease of less than 75% from baseline (18). For Lombardi and cols., PTH less than 10 pg/mL measured four or six hours after surgery predicted hypocalcemia with an overall accuracy of 98% (19). Pattou and cols.…”

Section: Resultsmentioning

confidence: 94%

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Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy

Vanderlei

Vieira

Hojaij

et al. 2012

Arq Bras Endocrinol Metab

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Objective: The purpose of this study was to evaluate if the measurement of peri-operative parathyroid hormone (PTH) is able to identify patients with increased risk of developing symptoms of hypocalcemia. Subjects and methods: Forty patients who underwent total thyroidectomy were studied prospectively. Ionized serum calcium and PTH were measured after induction of anesthesia, one hour (PTH1) and one day after surgery (PTH24). Patients were evaluated for symptoms of hypocalcemia and treated with calcium and vitamin D supplementation as necessary. Results: Symptomatic hypocalcemia developed in 16 patients. Symptomatic patients had significant lower PTH1 and greater drops in PTH levels. The selection of 12.1 ng/L as PTH1 level cutoff level divided patients with and without symptoms with 93.7% sensitivity and 91.6% specificity. The selection of 73.5% as the cutoff value for PTH decrease resulted in 91.6% sensitivity and 87.5% specificity. Conclusion: PTH1 levels and the drop in PTH levels are reliable predictors of developing symptomatic hypocalcemia after total thyroidectomy. Arq Bras Endocrinol Metab. 2012;56(3):168-72 Keywords Thyroid gland; PTH; hypocalcemia; thyroidectomy; parathyroid gland RESUMO Objetivo: O objetivo deste estudo é avaliar se a medida perioperatória do hormônio da paratireoide (PTH) pode identificar os pacientes com maior risco de desenvolver sintomas de hipocalcemia. Sujeitos e métodos: Foram estudados quarenta pacientes submetidos à tireo diectomia total. A medida do cálcio sérico e do PTH foi feita após a indução anestésica, uma hora (PTH1) e um dia após a cirurgia. Os pacientes foram avaliados quanto à presença de sintomas de hipocalcemia e tratados com suplementação de cálcio e vitamina D quando necessário. Resultados: Dezesseis pacientes apresentaram sintomas de hipocalcemia. Os pacientes sintomáticos apresentaram PTH1 significantemente menor e queda no PTH significativamente maior. Usando o valor de 12,1 ng/L como corte, conseguimos distinguir pacientes com e sem sintomas de hipocalcemia com sensibilidade de 93,7% e especificidade de 91,6%. Utilizando como corte a queda de 73,5% no valor do PTH, temos sensibilidade de 91,6% e especificidade de 87,5%. Conclusão: O PTH1 e a queda no PTH são bons preditores de hipocalcemia no pós-operatório de tireoidectomia total Arq Bras Endocrinol Metab. 2012;56(3):168-72

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Section: Resultsmentioning

confidence: 94%

“…Almost all studies define hypocalcemia as either low serum calcium or development of symptoms of hypocalcemia (9,11,(15)(16)(17)(18)(19)(21)(22)(23)(24)(25)(26). We used only the symptoms of hypocalcemia because we believe that mixing two parameters (biochemical hypocalcemia and symptomatic hypocalcemia) can introduce a bias.…”

Section: Resultsmentioning

confidence: 99%

Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy

Vanderlei

Vieira

Hojaij

et al. 2012

Arq Bras Endocrinol Metab

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“…Several studies show that low serum iPTH levels during postoperative period is a predictive factor for hypocalcemia (11,12,14,20,(26)(27)(28)(29).…”

Section: Discussionmentioning

confidence: 99%

“…It is not easy to predict in which patient hypocalcemia will occur. Clinical and biochemically relevant predictive factors of postoperative hypocalcemia constitute a controversial topic in the literature (11)(12)(13)(14). The aim is to identify patients with low risk of developing hypocalcemia who could be discharged early and those who need treatment and close monitoring.…”

mentioning

confidence: 99%

“…The aim is to identify patients with low risk of developing hypocalcemia who could be discharged early and those who need treatment and close monitoring. Recent studies have described the role of parathyroid hormone alone or combined with serum calcium levels as a predictive factor of hypocalcemia after thyroidectomy (11)(12)(13)(14). This study was designed to prospectively assess the utility of postsurgical iPTH levels in predicting postoperative hypocalcemia in total thyroidectomy.…”

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Hypocalcemia – the most common complication after total thyroidectomy

Cmilansky¹,

L²

2014

BLL

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Abstract:Objectiva: Postoperative intact parathyroid hormone (iPTH) levels and some other factors as a predictor of hypocalcemia are analyzed in 115 patients after TTE. Background: Postoperative hypocalcemia is the most common complication observed after total thyroidectomy (TTE). It is not easy to predict in which patients this complication will occur. We adopted and implemented a novel method to predict this complication -monitoring of postoperative intact parathyroid hormone (iPTH) levels. Methods and results: Prospective study involves 115 patients. From January till December 2010 we performed 111 TTE and 4 completion thyreoidectomies (hemithyreoidectomy (HTE) after previous HTE). Gender and age of patients, fi nal histopatology diagnosis, number of parathyroid glands visible during operation, duration of operation and surgeon were factors that did not infl uence development of postoperative hypocalcemia. A hospital stay was prolonged in patients with hypocalcemia. iPTH level morning after surgery less than 15 pg/ml was a statistically signifi cant predictor of postoperative hypocalcemia. Sensitivity, specifi city, positive and negative predictive value of iPTH<15 pg/ml for predicting postoperative hypocalcemia were 71 %, 99 %, 97 % and 86 %, respectively. Sensitivity of iPTH<15 pg/ml in predicting symptomatic postoperative hypocalcemia was 100 %. Conclusion: Measuring iPTH levels morning after TTE allows prediction of subsequent hypocalcemia with a high sensitivity, specifi city, PPV and NPV. Normal iPTH levels ruled out development of hypocalcemia symptoms. Patients with normal iPTH can be safely discharged and the overtreatment of postthyroidectomy patients with calcium and/or vitamin D supplements can be also avoided (Tab. 2, Fig. 3 Acknowledgement: I would like to thank prof. MUDr. Astl J., CSc., Department of ENT, head and neck surgery, Na Homolce Hospital, Prague, Czech Republic who helped me to start with thyroid surgery. My thanks also belongs to prof. MUDr. Starek I.,CSc., ENT clinic, Faculty Hospital Olomouc, Czech Republic and Doc. MUDr. Fryšák Z., CSc., 3rd intern clinic, Faculty Hospital Olomouc, Czech Republic for critical revision and for support to organise this study.

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Prospective Study of Perioperative Factors Predicting Hypocalcemia After Thyroid and Parathyroid Surgery

Chia

Weisman²,

Tieu³

et al. 2006

Arch Otolaryngol Head Neck Surg

116

111

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Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurement

Cited by 184 publications

References 14 publications

Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy

Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy

Hypocalcemia – the most common complication after total thyroidectomy

Prospective Study of Perioperative Factors Predicting Hypocalcemia After Thyroid and Parathyroid Surgery

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