Prospective evaluation of intra-operative quick parathyroid hormone assay as an early predictor of post thyroidectomy hypocalcaemia

Abstract

Parathyroid hormone assay twenty minutes after thyroidectomy is an accurate and reliable means of predicting clinically relevant hypocalcemia. Patients with PTH values greater than 9 pmol/L twenty minutes after thyroidectomy, can be safely discharged on the same postoperative day as the probability of life threatening hypocalcemia is unlikely.

Parathyroid Hormone Assays following Total Thyroidectomy: Is There a Predictive Value?

“…The value of determining serum parathyroid hormone (PTH) levels as a biological risk marker for hypoPTH occurrence is largely recognized, and the realization of this early assay (at the point of skin closure) appears to give results comparable to those taken several hours following the procedure [2, 3]. However, the practical application of this assay is not consensual.…”

The role and timing of parathyroid hormone determination after total thyroidectomy

“…Patients with either symptomatic hypocalcemia or serum calcium level <1.9 mmol/L were supplemented with 500-1,500 mg oral calcium daily with the addition of calcitriol 0.25 mcg twice daily for persistent hypocalcemia. With an IOPTH threshold of 9 pg/mL, another prospective study (6) of 100 patients demonstrated similar results. IOPTH levels were drawn 20 minutes after thyroidectomy with the patient still anesthetized.…”

“…comorbidities play a minimal role (6,7,(12)(13)(14)(15). Results regarding preoperative factors including 25-OH vitamin D, serum calcium, or parathyroid hormone (PTH) levels, or indications for surgery such as Graves' disease have been variable with no clear association to the development of postoperative hypocalcemia.…”

Effect of general anesthesia and intubation on parathyroid levels in normal patients and those with hyperparathyroidism

“…Moreover, it assists surgical decision making (ie, whether to explore the neck for another adenoma or hyperplasia), thus enabling a 95% cure rate for primary hyperparathyroidism (HPT) . Another advantage of intraoperative PTH measurement is to predict transient or permanent hypocalcaemia after thyroidectomy or extensive neck surgery . Consequently, it is necessary to comprehend the factors that may alter PTH blood levels in the surgical setting.…”

“…[1][2][3][4][5] Another advantage of intraoperative PTH measurement is to predict transient or permanent hypocalcaemia after thyroidectomy or extensive neck surgery. [6][7][8][9] Consequently, it is necessary to comprehend the factors that may alter PTH blood levels in the surgical setting.…”