Peer review report 1 on “Prophylactic Oral Calcium Supplementation Therapy To Prevent Early Post Thyroidectomy Hypocalcemia and Evaluation of Postoperative Parathyroid Hormone Levels to Detect Hypocalcemia: A Prospective Randomized Study”

Background: Detecting post-operative hypocalcaemia following total thyroidectomy using serum parathyroid hormone levels would help in an earlier and a definitive treatment plan in treating hypocalcaemia.Methods: This was a prospective interventional study done in a tertiary care teaching hospital. This was mainly done to assess the post-operative hypocalcemia following total thyroidectomy using parathyroid hormone levels and to assess the correlation between the two. With a baseline levels recorded patients underwent a post-operative evaluation of parathyroid hormone 1 hour after total thyroidectomy and serum calcium levels on day 1, 2, 3 and 4 after surgery. The same was statically analyzed to find a correlation between parathyroid hormone levels and the degree of hypocalcemia and evaluated to see if parathyroid hormone was a reliable clinical indicator.Results: A total of 43 patients were included in the study and the parathyroid hormone levels were assessed following surgery, the same was plotted statistically. Sensitivity of parathyroid hormone drop by 75% in predicting hypocalcaemia was 95%. 50% drop in parathyroid hormone levels was a sensitive predictor of hypocalcaemia. A PTH value of less than 15.1pg/ml was highly specific and sensitive indicator of hypocalcaemia.Conclusions: Parathyroid hormone Assay following total thyroidectomy is reliable for early prediction of hypocalcaemia. Patients with a parathyroid hormone level <9pg/ml or with 75% drop in parathyroid hormone level are at a high risk for hypocalcaemia and would require calcium supplementation.

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Hypoparathyroidism and pseudohypoparathyroidism

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302006000400012 ◽

2006 ◽

Vol 50 (4) ◽

pp. 664-673 ◽

Cited By ~ 42

Author(s):

Sergio S. Maeda ◽

Erika M. Fortes ◽

Ulisses M. Oliveira ◽

Victoria C.Z. Borba ◽

Marise Lazaretti-Castro

Keyword(s):

Vitamin D ◽

Parathyroid Hormone ◽

Basal Ganglia ◽

Calcium Supplementation ◽

Free Calcium ◽

Principal Function ◽

Active Vitamin ◽

Basal Ganglia Calcification ◽

Oral Calcium ◽

Glomerular Filtrate

The principal function of the parathyroid hormone (PTH) is maintenance of calcium plasmatic levels, withdrawing the calcium from bone tissue, reabsorbing it from the glomerular filtrate, and indirectly increasing its intestinal absorption by stimulating active vitamin D (calcitriol) production. Additionally, the PTH prompts an increase in urinary excretion of phosphorus and bicarbonate, seeking a larger quantity of free calcium available in circulation. Two mechanisms may alter its function, limiting its control on calcium: insufficient PTH production by the parathyroids (hypoparathyroidism), or a resistance against its action in target tissues (pseudohypoparathyroidism). In both cases, there are significantly reduced levels of plasmatic calcium associated with hyperphosphatemia. Clinical cases are characterized by nervous hyperexcitability, with paresthesia, cramps, tetany, hyperreflexia, convulsions, and tetanic crisis. Abnormalities such as cataracts and basal ganglia calcification are also typical of these diseases. Treatment consists of oral calcium supplementation associated with increased doses of vitamin D derivatives.

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