Predictable Criteria for Selective, Rather Than Routine, Calcium Supplementation Following Thyroidectomy

Landry, Christine S.; Grubbs, Elizabeth G.; Hernandez, Mike; Hu, Mimi I.; Hansen, Mandy O.; Lee, Jeffrey E.; Perrier, Nancy D.

doi:10.1001/archsurg.2011.1406

Cited by 46 publications

(20 citation statements)

References 14 publications

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“…La principal indicación de tiroidectomía fue la patología maligna, siendo el carcinoma papilar la histología más frecuente, lo que coincide con los reportes de AlQahtani 27 , Cayo 22 y Landry 21 , pero diferente de la mayoría de publicaciones, donde la principal causa fueron las patologías benignas 7,[11][12][13]16,18,19,25,[28][29][30]32 . El porcentaje de pacientes con hipocalcemia a las 12 horas fue cercano al 25 %, lo que se encuentra dentro del rango reportado en diversos estudios 4,7,[11][12][13]19,20,[22][23][24][25][26][27]29,31,32,34 .…”

Section: Discussionunclassified

“…La hormona paratiroidea (PTH), o paratohormona, es regulada de forma primaria por los nive-les séricos de calcio ionizado y, una vez secretada, se elimina rápidamente del plasma, con una vida media de dos a cuatro minutos 14,15 . Basados en lo anterior, múltiples estudios avalan la medición de la PTH como una prueba útil para la detección de los pacientes con alto riesgo de hipocalcemia posterior a una cirugía de tiroides; sin embargo, hay heterogeneidad sobre los métodos y la hora idónea para realizar la prueba 2,4,7,12,13,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] .…”

Section: Introductionunclassified

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Tiempo óptimo para medición de paratohormona como predictor de hipocalcemia en pacientes posterior a tiroidectomía total

et al. 2021

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Introducción. La hipocalcemia posterior a tiroidectomía total es una complicación frecuente en la cirugía de tiroides. La hormona paratiroidea ha demostrado ser un predictor confiable para detectar los pacientes con alto riesgo de hipocalcemia significativa y la consecuente necesidad de administrar suplemento de calcio. El objetivo de este estudio fue determinar el tiempo óptimo de medición de la paratohormona para dicho fin. Métodos. Estudio prospectivo realizado en dos instituciones de nivel III en Popayán, Colombia, entre abril de 2016 y febrero de 2018, en el cual se midieron niveles de paratohormona prequirúrgico, a las 0, 2, 4 y 12 horas del postoperatorio, y se compararon con los valores obtenidos a los 3 meses de seguimiento en pacientes sometidos a tiroidectomía total. Se consideró como grupos de riesgo y con necesidad de suplemento de calcio un valor de paratohormona menor de 10 pg/ml o una disminución mayor del 80 % con respecto al valor prequirúrgico. Resultados. Se incluyeron 34 pacientes intervenidos. Tomando como umbral un valor menor de 10 pg/ml, la medición de paratohormona a las 4 horas fue sensible y específica (60 y 93,1 % respectivamente). Para una disminución mayor del 80 % con respecto al valor prequirúrgico, la sensibilidad fue del 60 % y la especificidad del 96,5 %, presentando un valor predictivo positivo de 75 % y negativo del 93,3 %, con una p < 0,001. Discusión. Una disminución mayor del 80 % del valor de paratohormona prequirúrgico medida a las 4 horas después de la tiroidectomía total permite identificar aquellos pacientes con alto riesgo de hipocalcemia significativa, que requieren administración temprana de suplementos de calcio, comparado con la determinación de la disminución a las 0, 2 y 12 horas postoperatorias.

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Section: Discussionunclassified

Section: Introductionunclassified

Tiempo óptimo para medición de paratohormona como predictor de hipocalcemia en pacientes posterior a tiroidectomía total

et al. 2021

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“…Biochemical cutoffs were defined as POD1 PTH ≤ 10 pg/dL and serum Calcium of ≤ 8.0 mg/dL. Clinical factors were chosen based on previously reported associations with postoperative hypocalcemia and included parathyroid autotransplantation, lymph node dissection, diagnosis of Graves’ Disease and presence of parathyroid tissue in the pathology specimen (1, 2, 4-7, 10, 12-18, 21, 22). …”

Section: Methodsmentioning

confidence: 99%

One-hour PTH after thyroidectomy predicts symptomatic hypocalcemia

White

James

Nocon

et al. 2016

Journal of Surgical Research

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Background A major morbidity following total thyroidectomy is hypocalcemia. While many clinical factors and laboratory studies have been correlated with both biochemical and symptomatic hypocalcemia, the ideal use and timing of these tests the remains unclear. We hypothesize one-hour (PACU) PTH will identify patients at risk for symptomatic hypocalcemia. Methods This prospective study evaluated 196 patients undergoing total thyroidectomy. Serum calcium and PTH levels were measured one hour after surgery and on postoperative day 1 (POD1). Performance of a central compartment lymph node dissection, parathyroid autotransplantation, indication for procedure, pathology, and presence of parathyroid tissue in the pathology specimen were recorded. Results Of 196 patients, 9 (4.6%) developed symptomatic hypocalcemia. 34 (17.3%) had a 1-hour PACU PTH ≤ 10 pg/dL while 31 (15.8%) had a POD1 PTH of ≤ 10. Five (56%) of the nine symptomatic patients underwent central compartment lymph node dissection, 4 (44%) had parathyroid autotransplantation and 4 (44%) had a PACU PTH ≤10. PACU and POD1 PTH levels were correlated (R2=0.682). Multivariate regression identified central compartment dissection, autotransplantation, and PACU or POD1 PTH correlated with symptomatic hypocalcemia. PACU PTH, POD1 PTH, PACU Ca, malignant final pathology, and Age ≤ 45 years correlated with biochemical hypocalcemia. Conclusion 1-hour postoperative PACU PTH is equivalent to POD1 PTH in predicting the development of symptomatic hypocalcemia. Biochemical hypocalcemia was not predictive of symptoms in the immediate post-operative period. Lymph node dissection and parathyroid autotransplantation correlated with symptomatic hypocalcemia and improve the sensitivity of biochemical screening alone.

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“…However, whether routine calcium and vitamin D supplementation can decrease the risk of symptomatic hypocalcemia after thyroidectomy remains undetermined. Some studies reported that routine calcium and/or vitamin D supplementation was effective in preventing postoperative symptomatic and biochemical hypocalcemia [111213], whereas other studies reported no benefits [1415]. These inconsistent results were probably due to the different doses of supplemented calcium; a higher dose of elemental calcium supplement (2,000–3,000 mg/day) usually resulted in a reduced risk of hypocalcemia, whereas a lower dose (600 mg/day) showed no effect.…”

Section: Introductionmentioning

confidence: 99%

“…Additional laboratory assessments to prevent hypercalcemia can be burdensome and incur extra medical costs. High calcium doses or hypercalcemia may further suppress normal parathyroid hormone (PTH) secretion and prolong suppression of the parathyroid glands [14]. Stimulated by these observations, we investigated the use of low-dose calcium supplementation for preventing postoperative hypocalcemia.…”

Section: Introductionmentioning

confidence: 99%

Routine low-dose calcium supplementation after thyroidectomy does not reduce the rate of symptomatic hypocalcemia: a prospective randomized trial

et al. 2019

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Purpose Routine supplementation of high-dose calcium significantly decreased the risk of postoperative symptomatic hypocalcemia after thyroidectomy. However, there is an ongoing debate about whether the same results can be achieved with low-dose calcium supplementation. Methods Patients (n = 138) who underwent total thyroidectomy for thyroid cancer were 1:1 randomly assigned to receive oral supplements of 1,500 mg/day elemental calcium and 1,000 IU/day cholecalciferol for 2 weeks or no supplementation. Primary objective was to compare the incidence of symptomatic hypocalcemia for 3 days after total thyroidectomy. Secondary objective was to find the predictors for postoperative hypocalcemia in patients with thyroid cancer. Results Sixty-five patients in the calcium group and 69 patients in the control group were finally analyzed. The incidence of symptomatic hypocalcemia showed no difference between the calcium and control group (32.3% vs. 21.7%, P = 0.168). The total dosage of intravenous calcium (593.4 ± 267.1 mg vs. 731.6 ± 622.7 mg, P = 0.430) administered to patients with symptomatic hypocalcemia was also comparable between groups. In a multivariate analysis, parathyroid hormone level of 13 pg/mL at postoperative day 1 was only predictive for symptomatic hypocalcemia, and its incidence was 20.9 times (95% confidence interval, 6.8–64.5) higher in patients with parathyroid hormone <13 pg/mL. Other factors did not predict the development of hypocalcemia, including clinicopathological features and routine supplementation of low-dose calcium. Conclusion Routine low-dose calcium supplementation did not reduce the risk of postoperative hypocalcemia. Patients who may benefit from calcium supplementation should be carefully selected.

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Predictable Criteria for Selective, Rather Than Routine, Calcium Supplementation Following Thyroidectomy

Cited by 46 publications

References 14 publications

Tiempo óptimo para medición de paratohormona como predictor de hipocalcemia en pacientes posterior a tiroidectomía total

Tiempo óptimo para medición de paratohormona como predictor de hipocalcemia en pacientes posterior a tiroidectomía total

One-hour PTH after thyroidectomy predicts symptomatic hypocalcemia

Routine low-dose calcium supplementation after thyroidectomy does not reduce the rate of symptomatic hypocalcemia: a prospective randomized trial

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