Serum intact parathyroid hormone as a predictor of hypocalcaemia after total thyroidectomy

Soon, Patsy; Magarey, Christopher; Campbell, Peter; Jalaludin, Bin

doi:10.1111/j.1445-2197.2005.03593.x

Cited by 55 publications

(41 citation statements)

References 8 publications

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“…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%

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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: Introductionmentioning

confidence: 99%

“…It is the result of parathyroid gland injury and can cause great discomfort to the patient (1,(4)(5)(6)(7)(8).…”

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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“…Symptomatic hypocalcemia is extremely unpleasant, it extends the hospitalization time (1)(2)(3)(6)(7)(8) and it increases the treatment cost. Additionally, it is a consequence of parathyroid hypofunction.…”

Section: Introductionmentioning

confidence: 99%

Postoperative calcium levels as a diagnostic measure for hypoparathyroidism after total thyroidectomy

Rosa

Matos

Cernea

et al. 2015

Arch. Endocrinol. Metab.

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Objective: The aim of the present study was to identify a fast, efficient and low-cost method to diagnose hypoparathyroidism after total thyroidectomy. Materials and methods: One hundred and forty medical records, which contained patients' clinical and laboratory data, were retrospectively analyzed. Patient parathyroid hormone values, which were obtained immediately following operation, were compared with their ionized calcium levels the morning after surgery. This comparison was used to examine the correlation between the two variables in predicting hypoparathyroidism because measuring calcium levels is low-cost and more available in the hospitals compared to measuring parathormone (PTH) levels. Results: There was a positive and statistically significant correlation between PTH and ionized calcium values (Pearson correlation coefficient, r = 0.456; p < 0.0001). The values of first postoperative day ionized calcium levels (stratified by the 1.10 mmol/l cut-off value) were tested as a diagnostic measure for hypoparathyroidism, and a PTH < 15 pg/mL obtained immediately following operation served as a reference. This analysis showed that ionized calcium levels measured on the first postoperative day had a sensitivity of 45.6% (95% CI 30.9-61.0%), a specificity of 88.9% (95% CI 80.5-94.5%) and an accuracy of 76.7% (95% CI 68.7-83.5%) as a diagnostic measure for hypoparathyroidism. Conclusion: In conclusion, we demonstrated that patients who had high ionized calcium levels on the first postoperative day also had high PTH levels immediately following operation and, therefore, they had lower rates of hypoparathyroidism. Arch Endocrinol Metab. 2015;59(5):428-33

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“…Noordzij et al 13 analyzed the pooled data from nine studies, finding that the PTH level 6 hours after surgery had the highest accuracy for predicting hypocalcemia. Based on the analysis of published Australian data, [21][22][23] The Australian Endocrine Surgeons Guidelines currently recommends the routine measurement of PTH 4 hours after total thyroidectomy to guide postoperative calcium supplementation. 24 Schlottman et al 25 suggested that the greatest sensitivity and specificity in predicting hypocalcemia are achieved when looking at the decline in PTH from baseline rather than the absolute value, demonstrating that no patient with a decrease in PTH <35% developed hypocalcemia and all patients with a decrease >80% (14% of the cohort) became hypocalcemic in a study of 106 patients.…”

Section: Discussionmentioning

confidence: 99%

Selective Prophylactic Calcium Supplementation reduces Length of Stay after Total Thyroidectomy

Osborne¹,

Papachristos²,

Skandarajah³

et al. 2017

World Journal of Endocrine Surgery

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Serum intact parathyroid hormone as a predictor of hypocalcaemia after total thyroidectomy

Abstract: Serum PTH 1-h after total thyroidectomy is a reliable predictor of hypocalcaemia and can allow safe early discharge of patients from hospital.

Cited by 55 publications

References 8 publications

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

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

Postoperative calcium levels as a diagnostic measure for hypoparathyroidism after total thyroidectomy

Selective Prophylactic Calcium Supplementation reduces Length of Stay after Total Thyroidectomy

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