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

Vanderlei, Felipe Augusto Brasileiro; Vieira, José Gilberto H.; Hojaij, Flávio; Cervantes, Onivaldo; Kunii, Ilda S.; Ohe, Monique Nakayama; Santos, Rodrigo de Paula; Abrahão, Márcio

doi:10.1590/s0004-27302012000300003

Cited by 40 publications

(39 citation statements)

References 28 publications

(41 reference statements)

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“…After operation, clinical symptoms and signs such as numbness and tetany, as well as serum Ca level should be monitored. Some suggested that an early postoperative decrease in serum iPTH concentrations (8,10), combining with serum Ca concentration may predict hypoparathyroidism and guide the administration of Ca or vitamin D supplements (18,19). Post-operative hypoparathyroidism results from a reduction of functioning parathyroid parenchyma, which could be secondary to intraoperative damages caused by mechanical or thermal trauma, gland devascularization, obstruction of venous outflow, and inadvertent parathyroid excision (14,15,17).…”

Section: Risk Factors Leading To Postoperative Hypoparathyroidismmentioning

confidence: 99%

To identify or not to identify parathyroid glands during total thyroidectomy

Chang

Lang

2017

Gland Surg.

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Hypoparathyroidism is one of the most common complications after total thyroidectomy and may impose a significant burden to both the patient and clinician. The extent of thyroid resection, surgical techniques, concomitant central neck dissection, parathyroid gland (PG) autotransplantation and inadvertent parathyroidectomy have long been some of the risk factors for postoperative hypoparathyroidism. Although routine identification of PGs has traditionally been advocated by surgeons, recent evidence has suggested that perhaps identifying fewer number of in situ PGs during surgery (i.e., selective identification) may further lower the risk of hypoparathyroidism. One explanation is that visual identification may often lead to subtle damages to the nearby blood supply of the in situ PGs and that may increase the risk of hypoparathyroidism.However, it is worth highlighting the current literature supporting either approach (i.e., routine vs. selective) remains scarce and because of the significant differences in study design, inclusions, definitions and management protocol between studies, a pooled analysis on this important but controversial topic remains an impossible task. Furthermore, it is worth nothing that identification of PGs does not equal safe preservation, as some studies demonstrated that it is not the number of PGs identified, but the number of PG preserved in situ that matters. Therefore a non-invasive, objective and reliable way to localize PGs and assess their viability intra-operatively is warranted. In this aspect, modern technology such as the indocyanine green (ICG) as near-infrared fluorescent dye for real-time in situ PG perfusion monitoring may have a potential role in the future.

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Section: Risk Factors Leading To Postoperative Hypoparathyroidismmentioning

confidence: 99%

To identify or not to identify parathyroid glands during total thyroidectomy

Chang

Lang

2017

Gland Surg.

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“…Felipe Augusto Brasileiro Vanderlei et al in their study, forty patients who underwent total thyroidectomy were studied prospectively. 9 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.…”

Section: +mentioning

confidence: 99%

An early predictor of postoperative hypocalcemia: parathyroid hormone levels 1 hour after thyroidectomy

Rao

2017

Int Surg J

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Background: The present study compares ionized calcium (Ca 2+ ) levels with preoperative serum PTH and with those obtained at 1, 6 and 24 hours after total thyroidectomy with an emphasis on the 1-hour PTH (PTH-1) and the subsequent development of hypocalcemia. Methods: This is a retrospective study which consisted the cases of consecutive patients undergoing total or completion thyroidectomy between August 2010 and January 2012. Results: In this study, 200 patients were studied, out of which 24 (12%) were males and 176 (88) were females. The median age of patients in the entire cohort was 60 years. 151 (75.5%) patients underwent total thyroidectomy and 49 (24.5%) patients underwent complete thyroidectomy for malignancy of the entire cohort. 160 (80%) patients had been diagnosed of primary thyroid cancer. 40 (20%) were diagnosed of benign cancer. The mean PTH levels showed significantly higher at 24 hours postoperative in eucalcemic patients, but decreased by PTH-24. The r coefficients were compared between PTH-1, PTH-6 and PTH-24 were 0.85 and 0.99 thus reflecting the relative stability of PTH measurements within first 24 hours postoperative. Hypocalcemia (normal range-1.1-1.32 mmol/L) was 8 (4%) at 1 hour, 20 (10%) at 6 hour and 96 (48.2%) at 24 hour respectively. Factor PTH-1 >1.5 pmol/L, the Ca +2 <1.1 mmol/L were 8, the Ca +2 >1.1 mmol/L were 124, for factor PTH-1≤ 1.5 pmol/L, the Ca +2 <1.1 mmol/L were 68, the Ca +2 >1.1 mmol/L were 0. Conclusions: Those who are at risk of hypocalcemia 24 hours postoperatively, our results suggest that PTH-1 is an excellent predictor. To avoid hypocalcemia, therapy with calcitriol should be started if PTH-1 is less than 1.5 pmol/L.

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“…The early identification of patients at risk of hypoparathyroidism after total thyroidectomy helps to determine who would benefit from early calcium (Ca) supplementation (6), thereby, reducing the discomfort associated with many blood tests and high treatment costs (7). Thus, it is important to identify individuals at risk of hypoparathyroidism after total thyroidectomy with high accuracy.…”

Section: Introductionmentioning

confidence: 99%

Prediction of Transient and Permanent Hypoparathyroidism after Total Thyroidectomy Using the Postoperative Serum Parathyroid Hormone Test: When Is the Best Time to Check?

Kim

Bae

et al. 2017

J Endocr Surg

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Purpose: The usefulness of serum intact parathyroid hormone (iPTH) levels for predicting hypocalcemia after total thyroidectomy is well established. This retrospective cohort study aimed to identify the best time iPTH levels should be checked, and determine the postoperative day 1 iPTH level that most safely predict the development of permanent hypoparathyroidism after total thyroidectomy. Methods: All consecutive patients who underwent total thyroidectomy in 2013-2015 were identified, retrospectively. iPTH was measured at 2 hours after thyroidectomy, and on postoperative days 1 and 2, and 12 months after surgery. Results: In total, 730 patients were included. Their iPTH levels on postoperative day 2 correlated better with postoperative day 1 levels (Pearson's r=0.915) than with iPTH levels at 2 hours after total thyroidectomy (r=0.786). Fourteen patients had normal iPTH levels at 2 hours after thyroidectomy but abnormal levels on postoperative days 1 and 2. On the other hand, 38 patients had abnormal iPTH levels at 2 hours after thyroidectomy but normal values on postoperative days 1 and 2. Receiver operating characteristic analysis showed that the iPTH value of 3.05 pg/mL best predicted permanent hypoparathyroidism (sensitivity, 92.9%; specificity, 99.7%). The safe cutoff value was 9.65 pg/mL (sensitivity, 70.9%; specificity, 100%). Conclusion: A single measurement of iPTH on postoperative day 1 predicted patients at risk of transient hypocalcemia more accurately than measurements at 2 hours after surgery, and thus, can serve widely as a predictor of permanent hypoparathyroidism.

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

Cited by 40 publications

References 28 publications

To identify or not to identify parathyroid glands during total thyroidectomy

To identify or not to identify parathyroid glands during total thyroidectomy

An early predictor of postoperative hypocalcemia: parathyroid hormone levels 1 hour after thyroidectomy

Prediction of Transient and Permanent Hypoparathyroidism after Total Thyroidectomy Using the Postoperative Serum Parathyroid Hormone Test: When Is the Best Time to Check?

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