Predicting risk factors of postoperative hypocalcemia after total thyroidectomy: is safe discharge without supplementation possible? A large cohort study

Paladino, Nunzia Cinzia; Guérin, Carole; Graziani, J.; Morange, Isabelle; Loundou, Anderson; Taïeb, David; Sébag, F.

doi:10.1007/s00423-021-02237-2

Cited by 8 publications

(4 citation statements)

References 29 publications

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“…Several studies suggest that a within-the-normal-range PTH preoperatively and a low PTH in the early postoperative period can identify patients at risk for developing hypocalcemia after thyroidectomy [11][12][13][14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…Finally, in a very recent study by Paladino et al, the largest so far, including 477 total thyroidectomies, the research team used calcium values above 8.66 and PTH values above 44.3 pg/mL (4.70 pmol/L) to identify patients at a low risk for symptomatic hypocalcemia. They proposed an algorithm that could allow the discharge of up to 70% of patients in their cohort without the risk of hypocalcemia or overtreatment [17].…”

Section: Discussionmentioning

confidence: 99%

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Early Postoperative Parathormone and Calcium as Prognostic Factors for Postoperative Hypocalcemia

Daskalaki

Xenaki

Lasithiotakis

et al. 2022

JCM

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Background. Postoperative hypocalcemia is one of the most common complications after total thyroidectomy. Parathormone (PTH) and calcium levels, measured several hours after surgery, have been suggested as valuable markers for detecting patients at risk for post-thyroidectomy hypocalcemia. We aimed to determine if early post-surgery PTH and calcium levels can be used for the early identification of patients at risk for symptomatic hypocalcemia. Methods. PTH and calcium were measured before surgery and at 10 min and 4 h post-thyroidectomy, in 77 patients. Performance characteristics of PTH and calcium levels and their post/pre-surgery ratios were calculated. Results. Four-hour calcium was a sensitive (93.75%) but not specific (67.61%) indicator of patients at risk for symptomatic hypocalcemia. The 4-h/pre-surgery PTH ratio was the most accurate (90.81%) and the most specific (94.37%) test to identify patients at risk. Serum calcium at 4-h, 4-h/pre-surgery PTH ratio, and PTH at 10 min post-surgery had the higher diagnostic odds ratios (50.86, 32.85, and 29.04, respectively). The 4-h/pre-surgery PTH ratio also had the highest (0.694) Youden’s J statistic. Conclusions. Low serum calcium levels 4 h after thyroidectomy and the 4-h/pre-surgery PTH ratio could be valuable additions to everyday clinical practice in post-thyroidectomy patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Early Postoperative Parathormone and Calcium as Prognostic Factors for Postoperative Hypocalcemia

Daskalaki

Xenaki

Lasithiotakis

et al. 2022

JCM

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“…Del Rio et al, 2019). Paladino et al, (2021) showed that ionic calcium values below 2.00 mmol/l (2.25 mmol/l to 2.60 mmol/l) on the first postoperative day can predict hypocalcemia manifestations by approximately 50.0 % of cases (Paladino et al, 2021). According to Noordzij et al, (2007) and Richards et al, (2003), measuring ionic calcium at six hours and also one day after surgery, found a value of 1.00 mmol/l (1.12 mmol/l to 1.32 mmol/l) or less for symptomatic patients.…”

Section: Calcium Cut-off Valuementioning

confidence: 99%

Post-thyroidectomy hypocalcemia and related complications

Al-Roubaie

2022

ijhs

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The incidence of post-thyroidectomy hypocalcemia is high while the factors involved include age (> 50 years), type of operation, operative time, neck dissection, histology of the surgical specimen and vocal fold paralysis. Low ionic calcium concentrations are indicative of the presence of symptoms of hypocalcemia and the need for oral calcium. Progression to definitive hypoparathyroidism occurs only in patients with clinical manifestations of post-thyroidectomy hypocalcemia. In general, the problem with post-surgical hypoparathyroidism resides in the surgical procedure itself. The most common are related to neuronal hyperexcitability, which explains the paresthesias, cramps and numbness, which usually start in the perioral region and on the fingertips. Muscle spasms and muscle stiffness are also common. When severe, hypocalcemia can lead to life-threatening spastic tetany, laryngospasm, and seizures. The current manuscript aimed to present a review of the bibliography on thyroidectomy and negative impact of its complications on human health, mainly because of a higher risk for developing hypocalcemia. To achieve the study goal, this review covered most recent published articles from 2017 onward.

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“…In order to successfully treat hypocalcemia, calcium and vitamin D treatment needs to be properly managed. Another useful tool is the fluorescence technique, recently introduced for assessing parathyroid perfusion during thyroidectomy [ 11 ]. Moreover, distinctive autofluorescence has also been observed in parathyroid glands.…”

mentioning

confidence: 99%