Prospective Study of Perioperative Factors Predicting Hypocalcemia After Thyroid and Parathyroid Surgery

Chia, Stanley H.; Weisman, Robert A.; Tieu, David; Kelly, Colleen; Dillmann, Wolfgang H.; Orloff, Lisa A.

doi:10.1001/archotol.132.1.41

Cited by 117 publications

(136 citation statements)

References 16 publications

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“…Almost all studies define hypocalcemia as either low serum calcium or development of symptoms of hypocalcemia (9,11,(15)(16)(17)(18)(19)(21)(22)(23)(24)(25)(26). We used only the symptoms of hypocalcemia because we believe that mixing two parameters (biochemical hypocalcemia and symptomatic hypocalcemia) can introduce a bias.…”

Section: Resultsmentioning

confidence: 99%

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

Vanderlei

Vieira

Hojaij

et al. 2012

Arq Bras Endocrinol Metab

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Objective: The purpose of this study was to evaluate if the measurement of peri-operative parathyroid hormone (PTH) is able to identify patients with increased risk of developing symptoms of hypocalcemia. Subjects and methods: Forty patients who underwent total thyroidectomy were studied prospectively. 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. Results: Symptomatic hypocalcemia developed in 16 patients. Symptomatic patients had significant lower PTH1 and greater drops in PTH levels. The selection of 12.1 ng/L as PTH1 level cutoff level divided patients with and without symptoms with 93.7% sensitivity and 91.6% specificity. The selection of 73.5% as the cutoff value for PTH decrease resulted in 91.6% sensitivity and 87.5% specificity. Conclusion: PTH1 levels and the drop in PTH levels are reliable predictors of developing symptomatic hypocalcemia after total thyroidectomy. Arq Bras Endocrinol Metab. 2012;56(3):168-72 Keywords Thyroid gland; PTH; hypocalcemia; thyroidectomy; parathyroid gland RESUMO Objetivo: O objetivo deste estudo é avaliar se a medida perioperatória do hormônio da paratireoide (PTH) pode identificar os pacientes com maior risco de desenvolver sintomas de hipocalcemia. Sujeitos e métodos: Foram estudados quarenta pacientes submetidos à tireo diectomia total. A medida do cálcio sérico e do PTH foi feita após a indução anestésica, uma hora (PTH1) e um dia após a cirurgia. Os pacientes foram avaliados quanto à presença de sintomas de hipocalcemia e tratados com suplementação de cálcio e vitamina D quando necessário. Resultados: Dezesseis pacientes apresentaram sintomas de hipocalcemia. Os pacientes sintomáticos apresentaram PTH1 significantemente menor e queda no PTH significativamente maior. Usando o valor de 12,1 ng/L como corte, conseguimos distinguir pacientes com e sem sintomas de hipocalcemia com sensibilidade de 93,7% e especificidade de 91,6%. Utilizando como corte a queda de 73,5% no valor do PTH, temos sensibilidade de 91,6% e especificidade de 87,5%. Conclusão: O PTH1 e a queda no PTH são bons preditores de hipocalcemia no pós-operatório de tireoidectomia total Arq Bras Endocrinol Metab. 2012;56(3):168-72

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Section: Resultsmentioning

confidence: 99%

“…Symptoms of serum hypocalcemia may not be manifest for up to four days after surgery and can significantly lengthen hospital stay (4,(9)(10)(11). Finding a simple and reliable method to predict which patients may show hypocalcemia could decrease patient discomfort, hospital stay and treatment costs associated with total thyroidectomy.…”

Section: Introductionmentioning

confidence: 99%

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

Vanderlei

Vieira

Hojaij

et al. 2012

Arq Bras Endocrinol Metab

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“…Laboratory tests including perioperative PTH level, total calcium, ionized calcium, and phosphorus level were evaluated (3,(9)(10)(11)(12)(13)(14)(15)(16). In most of these studies, postoperative serum PTH was recommended as the most powerful predictor for post-thyroidectomy hypocalcemia, with a sensitivity ranging from 64% to 100% and a specificity ranging from 72% to 100%.…”

Section: Discussionmentioning

confidence: 99%

Percentage Decline of Parathyroid Hormone Level is a Predictor for Post-thyroidectomy Symptomatic Hypocalcemia

et al. 2017

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Purpose: Postoperative hypocalcemia is one of the most common complications after thyroid surgery. However, the predictive efficacy of parathyroid hormone (PTH) level was still controversial. We investigated the cut-off value of perioperative PTH level for postoperative hypocalcemia after total thyroidectomy. Methods: Four hundred eighty-two patients performed total thyroidectomy from January 2015 to December 2016 were enrolled. Demographics, operative variables and the development of symptomatic hypocalcemia were collected and evaluated. Results: Transient symptomatic hypocalcemia occurred in 83 (17.2%) patients and 5 (1.0%) patients have progressed to the permanent hypocalcemia. Patients with transient symptomatic hypocalcemia showed significantly lower postoperative day 1 PTH level than those without hypocalcemia (7.7±6.5 vs. 13.1±10.4 pg/mL; P<0.001), while correlation between postoperative PTH level and development of symptomatic hypocalcemia was not found in a multivariate analysis (P=0.122). Percentage decline of the preoperative PTH only showed significant association with transient hypocalcemia and the recommended cut-off value was 75.0%. When percentage decline of 75.0% was used, the incidence of transient hypoparathyroidism was 3.4 times (95% confidence interval, 2.1-5.6) higher in high percentage decline group (P<0.001). In regard to the permanent hypoparathyroidism, there were no significant differences in all factors. Conclusion: Percentage decline of PTH can be used as a predictive factor for postoperative hypocalcemia. Cautions against preventing injury of the parathyroid glands with careful surgical technique should be recommended.

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“…In this study, 96.15% of hypocalcaemia cases are transient. A patient undergoing total thyroidectomy risks vascular injury to the four parathyroid glands due to the requirement for bilateral dissection [12]. It is recommended that with careful dissection of the blood supply of the Table 1: Diagnosis of patients underwent thyroidectomy Table 2: Age Distribution of the patients and frequency of hypocalcaemia Table 3: Gender distribution of patients and frequency of hypocalcaemia parathyroid glands they can be spared.…”

Section: Discussionmentioning

confidence: 99%

Incidence of post-operative hypocalcaemia after thyroidectomy - a retrospective study

Raviraj

Vaseethan

2017

Sri Lanka j Surg

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Prospective Study of Perioperative Factors Predicting Hypocalcemia After Thyroid and Parathyroid Surgery

Cited by 117 publications

References 16 publications

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

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

Percentage Decline of Parathyroid Hormone Level is a Predictor for Post-thyroidectomy Symptomatic Hypocalcemia

Incidence of post-operative hypocalcaemia after thyroidectomy - a retrospective study

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