Hypoparathyroidism After Total Thyroidectomy

Asari, Reza; Passler, Christian; Kaczirek, Klaus; Scheuba, Christian; Niederle, Bruno

doi:10.1001/archsurg.2007.55

Cited by 269 publications

(260 citation statements)

References 26 publications

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“…Therefore, on the first 2 postoperative days, interpretation of iPTH levels in combination with sCa levels seems an optimal strategy for predicting patients at risk of hypoparathyroidism. 14 The overall incidence of transient and permanent hypoparathyroidism was 7.3% and 1.5%, respectively in a study by Thomusch O et al 15 Filho GJ demonstrated that there was transient hypocalcemia in 27.5%, permanent hypocalcemia in 5.1%. 16 Ozbas S et al in his study showed that after subtotal thyroidectomy 8.2% developed transient hypocalcaemia and 2.4% and 0.6% patients developed transient and permanent RLN palsy respectively.…”

Section: Resultsmentioning

confidence: 96%

Hypoparathyroidism, an innate risk of thyroidectomy

2017

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Background: The identification and preservation of parathyroid glands (PT) with its intact blood supply is of utmost importance during thyroid surgery. To preserve the PT with intact blood supply, a medial to lateral dissection is advocated, with plane of dissection along the thyroid capsule. One of the earliest and feared complications of thyroidectomy is hypoparathyroidism (HPT). Aim was to study the incidence of temporary and permanent hypoparathyroidism during thyroidectomy.Methods: This was a hospital based prospective study, from 2008 to 2015. 472 cases who underwent thyroidectomy (182 near total and 290 total thyroidectomies) for any indications in general surgery department of a tertiary care centre were included.Results: The incidence of permanent and transient HPT after total thyroidectomy was 3.8 and 09%, where as it was 2.75 and 3.85% after near total thyroidectomy. The results of present study were comparable with other studies.Conclusions: Meticulous dissection, absolute hemostasis, and a thorough knowledge of neck anatomy are the key in reducing the post thyroidectomy complications. Transient or permanent hypo parathyroidism is due to inadvertent gland removal or injury to its vascular pedicle. Dissection close to the thyroid capsule and ligation of capsular branches of thyroid avoiding the main trunk of inferior thyroid artery holds the key.

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Section: Resultsmentioning

confidence: 96%

Hypoparathyroidism, an innate risk of thyroidectomy

2017

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“…First of all, the definition of hypocalcemic symptom is subjective and arbitrary, and many previous studies have used their own definitions (13,(24)(25)(26)(27)(28)(29). The result of this study may be biased by the threshold for pain or tingling sensation of the patients.…”

Section: Discussionmentioning

confidence: 98%

“…Laboratory tests including perioperative PTH level, total calcium, ionized calcium, and phosphorus level were evaluated (3,(9)(10)(11)(12)(13)(14)(15)(16). In most of these studies, postoperative serum PTH was recommended as the most powerful predictor for post-thyroidectomy hypocalcemia, with a sensitivity ranging from 64% to 100% and a specificity ranging from 72% to 100%.…”

Section: Discussionmentioning

confidence: 99%

Percentage Decline of Parathyroid Hormone Level is a Predictor for Post-thyroidectomy Symptomatic Hypocalcemia

et al. 2017

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Purpose: Postoperative hypocalcemia is one of the most common complications after thyroid surgery. However, the predictive efficacy of parathyroid hormone (PTH) level was still controversial. We investigated the cut-off value of perioperative PTH level for postoperative hypocalcemia after total thyroidectomy. Methods: Four hundred eighty-two patients performed total thyroidectomy from January 2015 to December 2016 were enrolled. Demographics, operative variables and the development of symptomatic hypocalcemia were collected and evaluated. Results: Transient symptomatic hypocalcemia occurred in 83 (17.2%) patients and 5 (1.0%) patients have progressed to the permanent hypocalcemia. Patients with transient symptomatic hypocalcemia showed significantly lower postoperative day 1 PTH level than those without hypocalcemia (7.7±6.5 vs. 13.1±10.4 pg/mL; P<0.001), while correlation between postoperative PTH level and development of symptomatic hypocalcemia was not found in a multivariate analysis (P=0.122). Percentage decline of the preoperative PTH only showed significant association with transient hypocalcemia and the recommended cut-off value was 75.0%. When percentage decline of 75.0% was used, the incidence of transient hypoparathyroidism was 3.4 times (95% confidence interval, 2.1-5.6) higher in high percentage decline group (P<0.001). In regard to the permanent hypoparathyroidism, there were no significant differences in all factors. Conclusion: Percentage decline of PTH can be used as a predictive factor for postoperative hypocalcemia. Cautions against preventing injury of the parathyroid glands with careful surgical technique should be recommended.

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“…We used this value as a cut-off point for calculating sensitivity a predictive values of iPTH in predicting postoperative hypocalcemia. This value is often used in many studies (17,18,19). Some authors in their studies looked for other values of iPTH as a cut-off point to obtain better sensitivity, or specifi city or PPV/NPV: 13 pg/ml (20), 12 pg/ml (21,22).…”

Section: Methodsmentioning

confidence: 99%

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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Hypoparathyroidism After Total Thyroidectomy

Cited by 269 publications

References 26 publications

Hypoparathyroidism, an innate risk of thyroidectomy

Hypoparathyroidism, an innate risk of thyroidectomy

Percentage Decline of Parathyroid Hormone Level is a Predictor for Post-thyroidectomy Symptomatic Hypocalcemia

Hypocalcemia – the most common complication after total thyroidectomy

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