Same-day discharge after total thyroidectomy: The value of 6-hour serum parathyroid hormone and calcium levels

AbstractObjective:To determine whether pre-operative serum 25-hydroxyvitamin D has an impact on post-operative parathyroid hormone and serum calcium levels in patients undergoing total thyroidectomy for benign goitre.Methods:This single-centre, retrospective study comprised 246 unselected surgical patients who had undergone total thyroidectomy for bilateral, benign, multinodular goitre. The correlation between pre-operative serum 25-hydroxyvitamin D and post-operative serum parathyroid hormone and serum calcium was studied to determine whether low pre-operative serum 25-hydroxyvitamin D was predictive of post-operative hypocalcaemia.Results:Seventy-nine patients (32 per cent) had post-operative hypocalcaemia. Eighteen patients (7.32 per cent) experienced unintentional parathyroidectomy (1 parathyroid gland in 15 patients, 2 parathyroid glands in 3 patients). In univariate analysis, pre-operative serum 25-hydroxyvitamin D was not correlated with post-operative serum calcium (p = 0.69) or post-operative serum parathyroid hormone (p = 0.5804). Furthermore, in multivariate analysis, which took into account unintentional parathyroidectomy, no correlation was found (p = 0.33). Bilateral unintentional parathyroidectomy was statistically associated with post-operative hypocalcaemia (p = 0.032).Conclusion:Pre-operative serum 25-hydroxyvitamin D did not appear to have any impact on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre.

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Evaluation of Serum parathyroid hormone level measurement in total thyroidectomy patients

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v23i1.45105 ◽

2020 ◽

Vol 23 (1) ◽

pp. 5-10

Author(s):

Islam MS ◽

Sultana T ◽

Paul D ◽

Huq AHMZ ◽

Ferdoushi S ◽

...

Keyword(s):

Parathyroid Hormone ◽

Total Thyroidectomy ◽

Hormone Level ◽

Clinical Pathology ◽

T Test ◽

Parathyroid Hormone Level ◽

Serum Parathyroid Hormone ◽

Level Measurement ◽

Postoperative Hypoparathyroidism ◽

Serum Pth

Background: Postoperative hypoparathyroidism is a common complication after total thyroidectomy. It is necessary to diagnose hypoparathyroidism immediately after total thyroidectomy for minimizing complications. Objective: The objective of this study was to measure and to evaluate the serum parathyroid hormone level in total thyroidectomy patients. Methods: This prospective observational study was carried out in the Department of Clinical Pathology in collaboration with Department of Surgery & Department of Otolaryngology of BSMMU and Department of Otolaryngology of DMCH, Dhaka, during the period of September 2010 to August 2011. Results: Total 65 patients were studied irrespective of age and sex. Decreased serum PTH was found in 9 cases and normal parathyroid hormone was found in 56 cases. Male was 16.0% and female was 84.0%. Females were predominant. The incidence of hypoparathyroidism was 41.5%. Asymptomatic hypoparathyroidism was found in 8 and symptomatic hypoparathyroidism was found in 1 cases. Decreased serum PTH was developed mostly in malignant thyroid diseases. In relation to preoperative PTH values, intraoperative PTH levels were lower from 5.48% to 90.0%, (mean±SD in percentage is 65.3±16.7, p=.001) which is significant in paired t test. The mean difference of intraoperative (20 minutes after total thyroidectomy), parathyroid hormone levels were statistically significant (p<0.05) between patient with decreased parathyroid hormone and patient with normal parathyroid hormone in unpaired t-test. Conclusion: Serum parathyroid hormone level significantly decreased 20 minutes after total thyroidectomy. If clinical sign symptoms of hypoparathyroidism are not developed in postoperative period, patient is safe and can be discharged from hospital. Bangladesh J Otorhinolaryngol; April 2017; 23(1): 5-10

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The Predictive Value of Serum Parathyroid Hormone Levels for the Occurrence of Hypocalcemia Following Total Thyroidectomy

The Korean Journal of Endocrine Surgery ◽

10.16956/kjes.2013.13.1.19 ◽

2013 ◽

Vol 13 (1) ◽

pp. 19

Author(s):

Ahn Soo Na ◽

Seon Kwang Kim ◽

Young Wook Kim ◽

Hyun Jo Youn ◽

Sung Hoo Jung

Keyword(s):

Parathyroid Hormone ◽

Total Thyroidectomy ◽

Predictive Value ◽

Serum Parathyroid Hormone ◽

Hormone Levels

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Identifying early postoperative serum parathyroid hormone levels as predictors of hypocalcaemia after total thyroidectomy: A prospective non-randomized study

American Journal of Otolaryngology ◽

10.1016/j.amjoto.2020.102416 ◽

2020 ◽

Vol 41 (3) ◽

pp. 102416

Author(s):

Andro Košec ◽

Filip Hergešić ◽

Filip Matovinović ◽

Ivan Rašić ◽

Davor Vagić ◽

...

Keyword(s):

Parathyroid Hormone ◽

Total Thyroidectomy ◽

Randomized Study ◽

Serum Parathyroid Hormone ◽

Hormone Levels ◽

Postoperative Serum

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Safety, Efficacy, and Cost Savings of Single Parathyroid Hormone Measurement for Risk Stratification after Total Thyroidectomy

The American Surgeon ◽

10.1177/000313481307900816 ◽

2013 ◽

Vol 79 (8) ◽

pp. 768-774 ◽

Cited By ~ 10

Author(s):

Meghan McCullough ◽

Collin Weber ◽

Chris Leong ◽

Jyotirmay Sharma

Keyword(s):

Parathyroid Hormone ◽

Risk Stratification ◽

Total Thyroidectomy ◽

Calcium Supplementation ◽

Cost Savings ◽

Day Surgery ◽

Laboratory Cost ◽

Number Of Patients ◽

Same Day Discharge ◽

Hospital Stays

The management of hypocalcemia (HC) after total thyroidectomy (TTx) is a challenge as TTx is transitioned into a same-day surgery. Measurement of parathyroid hormone (PTH) level after TTx may allow for prediction of postoperative HC and lead to shorter hospital stays. A prospective database was queried between January 2010 and June 2012 with 95 patients who had undergone TTx identified. Patient demographics; preoperative diagnosis; laboratory values and cost; complications; intravenous calcium supplementation; and length of stay (LOS) were analyzed. A PTH-based algorithm was retrospectively applied and theoretical cost savings were analyzed in terms of laboratory cost, LOS, and total cost. Ninety-five patients underwent TTx: 37 patients (38.9%) had cancer, whereas 27 (28.4%) had Graves’ disease and the remaining 31 (32.6%) had a benign multinodular goiter. Postoperative PTH was recorded in 72 patients (74.4%); 46 (63.8%) had PTH greater than 10 pg/mL and 26 (36.9%) had PTH less than 10 pg/mL. Transient HC occurred in 10 patients (38.4%) with PTH less than 10 pg/mL (relative risk, 17.69; P = 0.0001). Patients with PTH less than 10 pg/mL incurred a 14.9 per cent higher hospital cost compared with those with PTH greater than 10 pg/mL. With retrospective implementation of the algorithm, there is a potential 46.4 per cent cost savings for the PTH less than 10 pg/mL group, 67.3 per cent savings for the PTH greater than 10 pg/mL group, and 46.7 per cent savings when taken altogether. Algorithmic risk stratification based on postoperative PTH less than 10 pg/mL serves as both a sensitive (100%) and specific (76.7%) predictor of postoperative HC. Such risk stratification may allow for same-day discharge in a number of patients, and even in patients requiring an overnight stay, result in cost savings as a result of a reduction in laboratory expenditures.

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