Reliable Early Prediction for Different Types of Post-Thyroidectomy Hypocalcemia

Kim, Joon Ho; Chung, Man Ki; Son, Young Ik

doi:10.3342/ceo.2011.4.2.95

Cited by 33 publications

(32 citation statements)

References 18 publications

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“…Numerous studies have been conducted on the factors involved in the early prediction of hypocalcemia following thyroidectomy, most of which measured postsurgical i-PTH and calcium levels 5-10. While calcium levels have been shown to have limited applicability as predictive factors, i-PTH levels have been reported to be useful in the prediction of postoperative hypocalcemia.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of an i-PTH Measurement in Predicting Post Thyroidectomy Hypocalcemia: Prospective Controlled Study

et al. 2013

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PurposeHypocalcemia is the most common complication after total thyroidectomy. The purpose of this study was to determine whether measurement of intact parathyroid hormone (i-PTH) level in thyroidectomy patients could predict hypocalcemia.Materials and MethodsWe performed a prospective study of patients undergoing total thyroidectomy. Serum concentration of i-PTH, total calcium (Ca), ionized calcium (Ca2+), phosphate (P), magnesium (Mg), and albumin were measured preoperatively and at 0 hour, 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours postoperatively.Results108 patients were recruited to the study. A total of 50 patients (46%) experienced hypocalcemia. The serum i-PTH concentration was linearly related to the time of measurement, while concentrations of P, Mg, albumin, Ca, and Ca2+ were not. We compared odds ratios, and found that the concentration of i-PTH at 6 hours post operation was the most closely related to the occurrence of hypocalcemic symptom. On ROC analysis using i-PTH level at 6 hours, an i-PTH level of 10.6 mg/dL was found to maximize both sensitivity and specificity at the same time point.ConclusionWe found that i-PTH was a predictor of hypocalcemia, and that the earliest predictor of hypocalcemic symptoms was an i-PTH concentration lower than 10.6 mg/dL obtained 6 hours after total thyroidectomy.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of an i-PTH Measurement in Predicting Post Thyroidectomy Hypocalcemia: Prospective Controlled Study

et al. 2013

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“…Therefore, hypocalcemia is one of the main outcomes for auditing and patient consent [5,6]. Inpatient admission and close monitoring of postoperative serum calcium level has been proposed to prevent postoperative symptoms related to hypocalcemia [7]. However, this approach has been criticized mainly due to the fact that the lowest concentration of serum calcium is usually not reached until 48 -72 hours after thyroidectomy; therefore, it has major implications for safe early discharge planning [8].…”

Section: Introductionmentioning

confidence: 99%

Role of Postoperative Vitamin D and/or Calcium Routine Supplementation in Preventing Hypocalcemia After Thyroidectomy: A Systematic Review and Meta-Analysis

2013

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Background. Transient hypocalcemia is a frequent complication after total thyroidectomy. Routine postoperative administration of vitamin D and calcium can reduce the incidence of symptomatic postoperative hypocalcemia. We performed a systematic review to assess the effectiveness of this intervention. The primary aim was to evaluate the efficacy of routine postoperative oral calcium and vitamin D supplementation in preventing symptomatic post-thyroidectomy hypocalcemia. The second aim was to draw clear guidelines regarding prophylactic calcium and/or vitamin D therapy for patients after thyroidectomy. Methods. We identified randomized controlled trials comparing the administration of vitamin D or its metabolites to calcium or no treatment in adult patients after thyroidectomy. The search was performed in PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Google Scholar, and Web of Knowledge databases. Patients with a history of previous neck surgery, calcium supplementation, or renal impairment were excluded.Results. Nine studies with 2,285 patients were included: 22 in the vitamin D group, 580 in the calcium group, 792 in the vitamin D and calcium group, and 891 in the no intervention group, with symptomatic hypocalcemia incidences of 4.6%, 14%, 14%, and 20.5%, respectively. Subcomparisons demonstrated that the incidences of postoperative hypocalcemia were 10.1% versus 18.8% for calcium versus no intervention and 6.8% versus 25.9% for vitamin D and calcium versus no intervention. The studies showed a significant range of variability in patients' characteristics. Conclusions. A significant decrease in postoperative hypocalcemia was identified in patients who received routine supplementation of oral calcium or vitamin D. The incidence decreased even more with the combined administration of both supplements. Based on this analysis, we recommend oral calcium for all patients following thyroidectomy, with the addition of vitamin D for high-risk individuals. The Oncologist 2013;18:533-542 Implications for Practice: Excision of the thyroid gland (thyroidectomy) is a common therapy for thyroid diseases. It is a safe procedure if performed by an expert surgeon. Temporary low serum calcium level (transient hypocalcaemia) is the most common complication of this surgery. This complication may occur in 10%-45% of the cases and may result in mild to severe symptoms. Postoperative treatment with calcium and vitamin D may prevent or minimize hypocalcemic symptoms; however, until now, clear guidelines for the optimal use of these supplements were not available. The aim of this review is to compare the outcomes of different supplementation protocols in an attempt to assist surgeons decrease the incidence of hypocalcemia after thyroid surgery. INTRODUCTIONThyroid surgery is one of the most frequently performed surgical procedures worldwide [1]. In fact, total thyroidectomy is now widelyacceptedasthegoldstandardforthemanagementofthyroid carcinoma and benign bilateral thyroid disease due to s...

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“…Considering the determination of the development of hypocalcemia based on post-operative iPTH levels is not an exact science, we believe giving lower doses of calcitriol only to those patients with an iPTH < 10 pg/ml, captures the majority of patients who would have been symptomatic, as well as minimizes the risks hypocalcemia and the costs of routine supplementation. Noting that the critical days for hypocalcemia occur with the nadir of calcium and the recovery time of the parathyroid glands, on POD # 2 and # 3, the amount of calcitriol given is pertinent [4, 27]. Calcitriol induces a fourfold increase in oral calcium uptake, as well as suppresses parathyroid function [28].…”

Section: Discussionmentioning

confidence: 99%

“…The strengths of the study were our inclusion of completion thyroidectomies and exclusion of lobectomies to more accurately include the population at risk. It has been well documented that completion thyroidectomies have higher complication rates, as compared to other thyroid procedures, due to the presence of adhesions and a more tenuous surgical field [27, 29]. In addition, we included patients who had a parathyroid gland re-implanted or included in the pathology specimen…”

Section: Discussionmentioning

confidence: 99%

An intact parathyroid hormone–based protocol for the prevention and treatment of symptomatic hypocalcemia after thyroidectomy

Carter

Chen

Sippel

2014

Journal of Surgical Research

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Background Symptomatic hypocalcemia after thyroidectomy is a barrier to same day surgery, and the cause of ER visits. A standard protocol of calcium and vitamin D supplementation, dependent on intact parathyroid hormone (iPTH) levels, can address this issue. How effective is it? When does it fail? Methods We performed a retrospective review of the prospective Thyroid Database from January 2006 to December 2010. 620 patients underwent completion (CT) or total thyroidectomy (TT), and followed our post-operative protocol of calcium carbonate administration for iPTH levels ≥10pg/ml and calcium carbonate and 0.25μg calcitriol BID for iPTH <10pg/ml. Calcium and iPTH values, pathology and medication, were compared to evaluate protocol efficacy. A p value <0.05 was considered statistically significant. Results Using the protocol, sixty-one (10.2%) patients were chemically hypocalcemic but never developed symptoms and twenty-four (3.9%) patients developed breakthrough symptomatic hypocalcemia. The symptomatic (SX) and asymptomatic (ASX) groups were similar with regard to gender, cancer diagnosis, and pre-operative calcium and iPTH. The symptomatic group was significantly younger (39.6 ± 2.8 vs. 49 ± 0.6 years, p=0.01), with lower post-operative iPTH levels. 33% (n=8) of SX patients had an iPTH ≤5 pg/ml vs. only 6% (n=37) of ASX patients. While the majority of patients with a PTH <5 pg/ml were asymptomatic, 62.5% (n=5) of SX patients with iPTH levels ≤5 pg/ml, required an increased in calcitriol dose to achieve both biochemical correction and symptom relief. Conclusion Prophylactic calcium and vitamin D supplementation based on post-operative iPTH levels can minimize symptomatic hypocalcemia after thyroidectomy. An iPTH ≤ 5pg/ml may warrant higher initial doses of calcitriol in order to prevent symptoms.

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Reliable Early Prediction for Different Types of Post-Thyroidectomy Hypocalcemia

Cited by 33 publications

References 18 publications

Effectiveness of an i-PTH Measurement in Predicting Post Thyroidectomy Hypocalcemia: Prospective Controlled Study

Effectiveness of an i-PTH Measurement in Predicting Post Thyroidectomy Hypocalcemia: Prospective Controlled Study

Role of Postoperative Vitamin D and/or Calcium Routine Supplementation in Preventing Hypocalcemia After Thyroidectomy: A Systematic Review and Meta-Analysis

An intact parathyroid hormone–based protocol for the prevention and treatment of symptomatic hypocalcemia after thyroidectomy

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