Postoperative PTH monitoring of hypocalcemia expedites discharge after thyroidectomy

Chow, Tam‐Lin; Choi, Chi‐Yee; Chiu, Annie Nga-King

doi:10.1016/j.amjoto.2014.07.006

Cited by 34 publications

(32 citation statements)

References 17 publications

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“…Using an earlier time point could result in classifying some patients as permanently hypoparathyroid when they could still show resolution of their condition. For example, Chow et al found that 2.8% [2] of patients developed permanent hypoparathyroidism, as defined at 6 months after surgery, even though this study used the same criteria for parathyroid gland function recovery as our study.…”

Section: Discussionmentioning

confidence: 92%

“…Others focus on medication administration, so recovery of parathyroid gland function is considered when the patient no longer requires therapeutic calcium or calcitriol supplementation to prevent symptoms of hypocalcemia [15, 16]. A third way to define recovery of parathyroid gland function is to determine when the serum PTH measurement is in the normal range and cessation of calcium or calcitriol supplementation occurs [2, 11, 17]. …”

Section: Introductionmentioning

confidence: 99%

“…Some consider postoperative parathyroid gland injury to be permanent if recovery of function has not occurred within 6 months [2, 11, 16, 18–20] while others define permanence at 1 year after surgery [15, 17]. …”

Section: Introductionmentioning

confidence: 99%

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Hypoparathyroidism after total thyroidectomy: incidence and resolution

Ritter

Elfenbein

Schneider

et al. 2015

Journal of Surgical Research

153

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Background Parathyroid hormone (PTH) levels are often measured after thyroid surgery and are used to detect patients at risk for postoperative hypoparathyroidism. However, there is a lack of consensus in the literature about how to define the recovery of parathyroid gland function and when to classify hypoparathyroidism as permanent. The goals of this study were to determine the incidence of low postoperative PTH in total thyroidectomy patients and to monitor their time course to recovery of parathyroid gland function. Methods We identified 1054 consecutive patients who underwent a total or completion thyroidectomy from 1/2006 to 12/2013. Low PTH was defined as a PTH measurement <10 pg/mL immediately after surgery. Patients were considered to be permanently hypoparathyroid if they had not recovered within 1 year. Recovery of parathyroid gland function was defined as PTH ≥10 pg/mL and no need for therapeutic calcium or activated vitamin D (calcitriol) supplementation to prevent hypocalcemic symptoms. Results Of 1054 total thyroidectomy patients, 189 (18%) had a postoperative PTH <10 pg/mL. Of those 189 patients, 132 (70%) showed resolution within 2 months of surgery. Notably, 9 (5%) resolved between 6–12 months. At 1 year, 20 (1.9%) were considered to have permanent hypoparathyroidism. Surprisingly, 50% of those patients had recovery of PTH levels yet still required supplementation to avoid symptoms. Conclusions Most patients with a low postoperative PTH recover function quickly, but it can take up to 1 year for full resolution. Hypoparathyroidism needs to be defined not only by PTH levels, but also by medication requirements.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Hypoparathyroidism after total thyroidectomy: incidence and resolution

Ritter

Elfenbein

Schneider

et al. 2015

Journal of Surgical Research

153

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“…6 In this study, 12 subjects had <12ng/ml parathyroid levels at 1,4,12 and 24 hours who were at high risk of developing hypocalcemia; started on oral calcium supplementation but later 2 (4%) out of 12 subjects developed symptoimatic hypocalcemia and 38 subjects had >/=12ng/ml parathyroid levels done at similar intervals as above were at low risk of developing hypocalcemia; although later 1 (2%) subjects developed symptomatic hypocalcemia as compared to study done by Chow et al, which used serum parathyroid levels as a criteria showed 2.8% of the patients developed hypocalcemia postoperatively. 7 Pattou et al, found that a postoperative PTH level of 12 pg/mL or less was a good predictor of hypocalcemia, but they did not state how long after surgery PTH values were obtained. 8 Lam and Kerr reported that all patients with a PTH level less than 8 pg/mL measured 1 hour after the surgery became hypocalcemic, and all patients with a PTH level greater than 9 pg/mL did not.…”

Section: Discussionmentioning

confidence: 99%

A prospective study on parathyroid hormone levels in detecting early hypocalcemia after total thyroidectomy

Kumar

Vinay

2017

Int Surg J

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Background: Hypoparathyroidism and the resultant hypocalcaemia is a major cause of postoperative morbidity after total thyroidectomy with the incidence varying from 1% to 71%. This study aims to determine the incidence of parathyroid hormone deficiency as an earliest indicator for detecting hypocalcemia following total thyroidectomy.Methods: A prospective study was carried out among 50 subjects attending Department of Surgery, K. R. Hospital, Mysuru over a period of 12 months. Subjects of either sex undergoing total thyroidectomy had their serum parathyroid hormone levels tested at 1, 4, 12 and 24 hours after surgery were included in the study. Patients with poor compliance, calcium supplementation prior to surgery, coexisting parathyroid or renal pathology were excluded from the study. Descriptive statistics and Pearson correlation coefficients were used to analyse the results.Results: Among 50 study subjects, Hypocalcemia developed in 3 subjects (6%) 24 hours after thyroidectomy showing a sensitivity, specificity, negative and positive predictive value of 91%, 100%, 98% and 96% respectively.Conclusions: Parathyroid hormone levels in postoperative total thyroidectomy is an earliest indicator to detect symptomatic hypocalcemia subjects 24 hours after surgery, which prompts early administration of oral calcium replacement therapy in high risk subjects and potential safe early discharge post-operatively.

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“…Conversely postoperative hypocalcemia may also occur after 48-72 hours after surgery, and is the most common cause of prolonged hospitalization after thyroid surgery (15,58). Transient hypocalcemia may occur in 25% of patients undergoing bilateral thyroid surgery and is permanent in 0.9-14% of cases (59,60). So, predicting which patients will be affected by hypocalcemic complication within the first 24 hours, is critical for planning an early discharge.…”

Section: Discussionmentioning

confidence: 99%