The Chvostek sign

Hoffman, Elmer

doi:10.1016/0002-9610(58)90868-7

Cited by 34 publications

(7 citation statements)

References 2 publications

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“…The reason for this result is unclear, but approximately 25% of healthy individuals have a ChvostekÕs sign. 17 In contrast, another study showed that 29% of patients with laboratory-confirmed hypocalcemia had a negative ChvostekÕs sign. 18 Since we did not examine preoperatively whether the ChvostekÕs sign was positive or not, we do not know the precise reason for this finding.…”

Section: Discussionmentioning

confidence: 97%

“…In our present study, Chvostek’s sign was observed about 30% of patients and there were no significant differences between the two groups. The reason for this result is unclear, but approximately 25% of healthy individuals have a Chvostek’s sign 17. In contrast, another study showed that 29% of patients with laboratory‐confirmed hypocalcemia had a negative Chvostek’s sign 18.…”

Section: Discussionmentioning

confidence: 99%

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A Prophylactic Infusion of Calcium Solution Reduces the Risk of Symptomatic Hypocalcemia in Patients after Total Thyroidectomy

et al. 2006

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

A Prophylactic Infusion of Calcium Solution Reduces the Risk of Symptomatic Hypocalcemia in Patients after Total Thyroidectomy

et al. 2006

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“…A positive Chvostek sign, that is, facial twitching elicited by tapping on the preauricular area of the facial nerve, can also be a sign of hypocalcemia. However, it may normally be present in 25% of individuals and was thus not considered a sign of symptomatic hypocalcemia 7 . Biochemical hypocalcemia was defined as a corrected serum calcium ≤1.9 mmol/L (7.6 mg/dL).…”

Section: Methodsmentioning

confidence: 99%

“…However, it may normally be present in 25% of individuals and was thus not considered a sign of symptomatic hypocalcemia. 7 Biochemical hypocalcemia was defined as a corrected serum calcium ≤1.9 mmol/L (7.6 mg/dL). Corrected serum calcium was determined by the formula {corrected serum calcium (mmol/L) = measured serum calcium + 0.02*(40 À serum albumin)}.…”

Section: Hypocalcemia Definitionsmentioning

confidence: 99%

Parathyroid hormone‐driven algorithms after thyroid surgery: Not one‐size‐fits‐all

et al. 2022

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Background Underreported variation in parathyroid hormone (PTH) assays exists. Using quality improvement methods, we aimed to develop an institution‐specific PTH‐based protocol to predict hypocalcemia after thyroidectomy. Methods We retrospectively reviewed patients who underwent total/completion thyroidectomy. A receiver operating curve (ROC) determined postoperative PTH cut‐offs predictive of hypocalcemia. The stakeholders developed PTH‐driven calcium management guidelines. Post‐implementation outcomes were prospectively measured. Results Pre‐implementation, 95 patients were assessed. PTH ≤1.5 pmol/L (14.1 pg/ml) predicted hypocalcemia (96%sensitivity), and ≥2.8 pmol/L (26.4 pg/ml) predicted normocalcemia (99%specificity) (area under curve = 0.97, SEM = 0.018). PTH on the day of and morning after surgery were identically predictive. Post‐implementation, 64 patients were assessed. Hypocalcemia occurred with PTH >2.8 pmol/L in 2 cases (3.1%). Calcium over‐prescribing decreased from 13.7% to 3.1% (p = 0.06). Length of stay (LOS) > 2 nights decreased from 13% to 3.1% (p = 0.05). Conclusion A PTH‐driven calcium management protocol post‐thyroidectomy effectively reduces unnecessary calcium replacement and LOS. Given the variability in PTH assays, each institution may need to use individual cut‐offs.

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“…The Chvostek sign is not reliable in determining the presence of hypoparathyroidism postoperatively, even though some authors rely on it (71, 72). Chvostek's sign is present in 27.8 per cent of normal persons without calcium deficiency or renal disease or other disorders (73, 74). In the age group 10‐19 years, the incidence is as high as 50.7 per cent in males and 62.5 per cent in females (73, 74).…”

Section: Postoperative Tetanymentioning

confidence: 99%

Carcinoma of the Thyroid in Patients Aged 50 or Older*

Hoffman

1974

J American Geriatrics Society

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At the Sinai Hospital of Baltimore, carcinoma of the thyroid was studied in 60 patients whose ages ranged from 50 to 79 years (Series AA). Data on the author's Series A (185 patients of various ages) and data from reports in the literature (children or adults of various ages) are used for comparison. Carcinoma of the thyroid is fairly common in the 50+ age group, constituting 32 per cent of the cases in patients of all ages (Series A). In the patients aged 50 or older (Series AA), the ratio of females to males was 5.7:1.0 versus 3.9:1.0 for patients of all ages. The thyroid carcinoma was multifocal in 18 per cent of the elderly patients. It was found incidentally upon physical examination in almost two‐thirds of the cases. Radioiodine tracing was of little help diagnostically. The best criterion for diagnosis is a high index of suspicion on the part of the physician. If thyroid nodules are treated aggressively, carcinoma can be diagnosed earlier. Often a preoperatively palpable nodule is not the one identified microscopically as containing carcinoma. Frozen‐section diagnosis can be misleading; in 46 per cent of Series AA, the frozen section was reported as benign whereas the permanent sections were reported as carcinoma. The treatment of choice is total thyroidectomy followed by radioiodine therapy if any foci of carcinoma are found by postoperative scanning. Prophylactic removal of lymph nodes is of no value. Thyroid substitution therapy should be started as soon as possible after operation. With use of the author's methods, postoperative tetany and vocal cord paralysis can be avoided. The mortality rate for thyroid carcinoma in the 60 patients of the 50+ age group was 25 per cent. Of the 15 deaths secondary to metastases, 7 were from solid or anaplastic, 5 from follicular, and 3 from papillary or mixed papillary carcinoma. Thus the papillary type is not always benign, as described by some authors. Thirty of the 60 patients were traceable five or more years after surgery. Of these, 10 had died from thyroid carcinoma, 1 had died from another cause, and 3 were alive but with metastases; however, 16 were alive and free of thyroid carcinoma.

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The Chvostek sign

Cited by 34 publications

References 2 publications

A Prophylactic Infusion of Calcium Solution Reduces the Risk of Symptomatic Hypocalcemia in Patients after Total Thyroidectomy

A Prophylactic Infusion of Calcium Solution Reduces the Risk of Symptomatic Hypocalcemia in Patients after Total Thyroidectomy

Parathyroid hormone‐driven algorithms after thyroid surgery: Not one‐size‐fits‐all

Carcinoma of the Thyroid in Patients Aged 50 or Older*

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