S139 – Intact Parathyroid Hormone as a Predictor of Hypocalcaemia

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P123-P123
Author(s):  
Yuk Hui Ng ◽  
Dawn Tw Teo ◽  
Mark Li-Chung Khoo
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Prospective Study ◽  
Total Thyroidectomy ◽  
Clinical Symptoms ◽  
High Sensitivity ◽  
Intact Parathyroid Hormone ◽  
Completion Thyroidectomy ◽  
Single Institution ◽  
Ipth Level

Objectives 1) To investigate intact Parathyroid Hormone (ipth) as a predictor of hypocalcaemia in post-total thyroidectomy patients. 2) To determine the sensitivity and specificity of ipth as a predictor of hypocalcaemia. Methods Prospective study involving 65 patients in a single institution accrued over 2 years. All patients scheduled for total thyroidectomy were empirically started on calcium and vitamin D replacement on the day of surgery. Intact Parathyroid Hormone (ipth) levels were taken 4–6 hours after completion of operation. Corrected calcium levels were also obtained 4–6 hours after completion of operation and 24 hours later. All patients were subsequently monitored for development of hypocalcaemia. Hypocalcaemia is defined as corrected serum calcium of < 1.9 mmol/L or clinical symptoms of cramps or peri-oral numbness. Results 18 of 65 patients developed hypocalcaemia. All patients who developed hypocalcaemia had a ipth level of < 0.6 pmol/L. Using 0.6 as a cut-off value, ipth has a sensitivity of 100% and specificity of 76% in our study. Conclusions Using a cut-off value of 0.6pmmol/L, early postoperative intact parathyroid hormone has a high sensitivity and good specificity in identifying patients who subsequently develop hypocalcaemia post-total or completion thyroidectomy and can be used identify patients who need close calcium monitoring in the postoperative period.

scholarly journals Measurement of serum intact parathyroid hormone (iPTH) at the end of total thyroidectomy: A reliable parameter for hypocalcemia?

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
A Lalos ◽  
K Linke ◽  
M von Flüe ◽  
B Kern
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Clinical Symptoms ◽  
Parathyroid Tissue ◽  
Postoperative Management ◽  
Parathyroid Glands ◽  
Intact Parathyroid Hormone ◽  
Postoperative Hypoparathyroidism ◽  
Symptomatic Hypocalcemia ◽  
The Mean

Abstract Objective Total thyroidectomy represents the gold standard surgical procedure for patients with malignant thyroid disease. Over the past decades, the total thyroidectomy gradually replaced the subtotal thyroidectomy for benign thyroid disorders as well. Postoperative hypocalcemia remains the most frequent complication. The close proximity of parathyroid glands to the thyroid capsule leads often to devascularization or adventitious removal of parathyroid tissue. Clinical symptoms like paresthesia, tingling, muscle cramps or seizures often occur. Combined measurement of intact parathyroid hormone (iPTH) and calcium after the operation are used worldwide to predict postoperative hypoparathyroidism. The purpose of this study was to find out the incidence of decreased iPTH at the end of surgery and its reliability in predicting hypocalcemia. Methods We performed a retrospective analysis of 534 patients who underwent total thyroidectomy at our institution between 2000 and 2019. Medical records were reviewed to analyze the patient characteristics, indication of the procedure, laboratory and histological results, postoperative management and complications. The iPTH was measured before and at the end of the surgery, while the calcium was measured at the first postoperative day. The iPTH assay at our hospital has a normal range between 15.0 and 80.0 pg/ml. Meanwhile hypocalcemia was defined as a calcium measurement &lt; 2.2 mmol/l. Results The mean age of the patients was 55.34 years. The female to male ratio was 4.6:1. The mean preoperative iPTH of our cohort was 48.35 pg/ml, while the postoperative iPTH was 31.74 pg/ml, indicating a mean reduction of 35.75%. A total of 174 patients (32.6%) had a iPTH &lt; 15.0 pg/ml at the end of the surgery, indicating a reduction of 75.6%. 22 of these 174 patients (12.6%) developed clinical symptoms of hypocalcemia. In contrast only 3 patients (0.08%) with normal iPTH developed symptoms. Whole parathyroid glands were identified in 95/534 (17.8%), whereas from the 174 patients with iPTH &lt; 15.0 pg/ml, 56 (32.2%) had at least one parathyroid gland in the operative specimens. Conclusion Measurement of iPTH at the end of total thyroidectomy is a good predictor to detect patient who are at risk for developing symptomatic hypocalcemia and calcium substitution can be started at the same day. A normal iPTH almost excludes symptomatic hypocalcemia.

scholarly journals A Prospective Study of Vitamin D Supplement in Thyroidectomy Patients Based on Relative Decline of Parathyroid Hormone

2021 ◽  
Vol 12 ◽  
Author(s):  
Qing Hao ◽  
Yun Qin ◽  
Wanjun Zhao ◽  
Lingyun Zhang ◽  
Han Luo
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
High Risk ◽  
Prospective Study ◽  
Oral Calcium ◽  
Group A ◽  
Relative Decline ◽  
A Prospective Study ◽  
Vitamin D Supplement ◽  
Intravenous Calcium

Background: In postthyroidectomy patients, hypocalcemia is the most common complication to prolong hospital stay and decrease patients’ satisfaction. Based on current evidence, it is recommended to supply vitamin D to patients with high risk of developing hypocalcemia. However, how to stratify the risk of patients remains challenging.Aim: We conducted a prospective study to evaluate the effect of vitamin D supplement (calcitriol) on high-risk hypocalcemia patients based on relative decline of parathyroid hormone (RDP).Method: RDP was calculated by the difference between preoperative and postoperative first-day PTH divided by preoperative PTH and presented as percentage. Patients who underwent total thyroidectomy in addition to bilateral central compartment dissection were enrolled prospectively and were divided into two cohorts: Cohort I: patients with RDP ≤70% and Cohort II: patients with RDP &gt;70%. Patients in Cohort I were then randomly assigned to Group A or B, and patients in Cohort II were randomly assigned to Group C or D. All groups received oral calcium, and patients in Groups B and D also received calcitriol. All patients were followed for one year. In the study, standard procedure dictates that only oral calcium is given to patients whose RDP ≤70% and that oral calcium and calcitriol are given to patients whose RDP &gt;70%. Therefore, Cohort I Group A and Cohort II Group D are controls in this study.Results: The incidence of clinical hypocalcemia in Groups A and D (the controls) was 11.0% (10/91), and 17.6% (16/91) required additional intravenous calcium. Of note, no patients developed permanent hypocalcemia. Furthermore, calcitriol supplement did not have significant impact on clinical outcomes between Group A and B in Cohort I. By contrast, calcitriol supplement distinctly improved clinical outcome by comparing Groups C and D (Cohort II), as marked by clinical hypocalcemia, need of requiring intravenous calcium, and long-termed decreased levels of PTH.Conclusion: Supplying calcitriol based on RDP cutoff of 70% may be a wise practice in thyroidectomy patients, and RDP 70% may be a useful predictor to stratify high-risk patients.

Management of Completion and Total Thyroidectomy Patients Based on 1-Hour Postoperative Parathyroid Hormone

2016 ◽  
Vol 82 (10) ◽  
pp. 881-884
Author(s):  
Joshua Park ◽  
Ethan Frank ◽  
Alfred Simental ◽  
Sara Yang ◽  
Christopher Vuong ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Early Discharge ◽  
Vitamin D Supplementation ◽  
Initial Management ◽  
Management Protocol ◽  
Symptomatic Hypocalcemia ◽  
Risk Patients ◽  
One Year

After thyroid surgery, protocols based on postoperative parathyroid hormone (PTH) levels may prevent symptoms of hypocalcemia, while avoiding unnecessary prophylactic calcium and/or vitamin D supplementation. We examined the value of an initial management protocol based solely on a single PTH level measured one hour after completion or total thyroidectomy to prevent symptomatic hypocalcemia by conducting a retrospective review of 697 consecutive patients treated from July 2003 to April 2015. The proportion of patients who developed symptomatic hypocalcemia was similar between those treated before (n = 155) and after (n = 542) implementation of this 1-hour PTH protocol (16.8% vs 15.9%; P = 0.786). Those in the 1-hour PTH groups had lower overnight observation rates (97.4% vs 53.7%; P < 0.001) and length of stay (1.98 ± 2.61 vs 0.89 ± 1.87 days; P < 0.001), and required less calcium (3.9% vs 0.8%; P = 0.015) and vitamin D (2.6% vs 0%; P = 0.002) supplementation one year after surgery. Less than 1 per cent of patients discharged on the day of surgery in accordance with the 1-hour PTH guidelines returned to the emergency room for symptomatic hypocalcemia; none experienced significant morbidity. This protocol facilitates early discharge of low-risk patients and results in a similar or improved postoperative course compared with traditional overnight observation.

scholarly journals Single measurement of intact parathyroid hormone after thyroidectomy can predict transient and permanent hypoparathyroidism: a prospective study

2017 ◽  
Vol 40 (5) ◽  
pp. 350-356 ◽  
Author(s):  
Montana Suwannasarn ◽  
Wallaya Jongjaroenprasert ◽  
Palapong Chayangsu ◽  
Ronnarat Suvikapakornkul ◽  
Chutintorn Sriphrapradang
Keyword(s):  
Parathyroid Hormone ◽  
Prospective Study ◽  
Intact Parathyroid Hormone ◽  
Permanent Hypoparathyroidism ◽  
Single Measurement ◽  
A Prospective Study

scholarly journals The importance of the unsuppressed glands in the study of intact parathyroid hormone disappearance after parathyroid adenomectomy

2001 ◽  
pp. 353-362 ◽  
Author(s):  
F Locchi ◽  
M Tommasi ◽  
ML Brandi ◽  
D Borrelli ◽  
P Cicchi ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
A Priori ◽  
Compartment Model ◽  
Constant Infusion ◽  
Intact Parathyroid Hormone ◽  
Theoretical Possibility ◽  
Ipth Level ◽  
Two Compartment Model ◽  
Disappearance Curve ◽  
Induction Of Anaesthesia

BACKGROUND: In the usual techniques for intraoperative intact parathyroid hormone (iPTH) monitoring for primary hyperparathyroidism, the normal glands are implicitly considered suppressed. On the contrary, we believe, as do other researchers, that they are not totally suppressed. METHODS: For this reason, we considered the introduction of an infusion from the unsuppressed normal glands (UNG), described by an influx constant (IC (pg/ml per min)), into the formulation of a two-compartment model. For the blood compartment, we have: C(t)=A.exp(-at)+B.exp(-bt)+EV, where A+B+EV=iPTH concentration at zero time (clamping), EV (equilibrium value)=IC/k, 'a' and 'b' are reciprocals of the time constants of the two exponentials and k=rate constant of elimination from the blood. The experimental data were obtained using an IRMA standard method, collecting samples in 20 patients, during and following adenomectomy. RESULTS: In spite of the variability among the patients, all fits were very good, thus confirming the importance of the UNG contribution to the shaping of the disappearance curve. For this reason, the relationship between the constant infusion from the UNG and the basal iPTH level at the induction of anaesthesia (BV), was studied. CONCLUSIONS: The existence of a negative correlation, together with the determination of a regression curve (IC=6.5BV), not only confirmed our assumptions, but also revealed the theoretical possibility of a priori knowledge of the iPTH contribution from the UNG. Hence, there is a theoretical possibility of discriminating between this contribution and that of the remaining (if any) affected gland(s).

scholarly journals Associations between Serum-Intact Parathyroid Hormone, Serum 25-Hydroxyvitamin D. Oral Vitamin D Analogs and Metabolic Syndrome in Peritoneal Dialysis Patients: A Multi-Center Cross-Sectional Study

2014 ◽  
Vol 34 (4) ◽  
pp. 447-455 ◽  
Author(s):  
Jie Dong ◽  
Qin Wang ◽  
Meng-Hua Chen ◽  
Hui-Ping Zhao ◽  
Tong-Ying Zhu ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Vitamin D ◽  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Lower Risk ◽  
Intact Parathyroid Hormone ◽  
Oral Vitamin ◽  
Vitamin D Analogs ◽  
Hydroxyvitamin D ◽  
25 Hydroxyvitamin D

Introduction Although previous studies have suggested associations between serum intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25(OH)D) and metabolic syndrome (MS) in the general population, these associations are still uncharacterized in peritoneal dialysis (PD) patients. Methods In total, 837 prevalent PD patients from 5 centers in China were enrolled between April 1, 2011 and November 1, 2011. The demographic data, biochemical parameters and medical records were collected, except for serum 25(OH)D which was measured in 347 of 837 patients. The definition of MS was modified from National Cholesterol Education Program Third Adult Treatment Panel (NCEP-ATPIII). Results 55.4% of 837 patients were found to have MS. The median concentration of iPTH, 25(OH)D and doses of oral vitamin D analogs for participants with MS was significantly lower than those without MS. The iPTH, 25(OH)D values and doses of vitamin D analogs were all associated with one or more components of MS. After multivariate adjustment, Low serum iPTH values and oral vitamin D analogs, rather than serum 25(OH)D, were significantly associated with the presence of MS, abnormal fasting blood glucose (FBG) and high-density lipoprotein cholesterol (HDL-C). Compared to iPTH < 130pg/mL, iPTH 130–585 pg/mL and > 585pg/mL were associated with a lower risk of MS with adjusted odds ratio (OR) of 0.59 and 0.33, respectively. Taking vitamin D analogs was also associated with a lower risk of MS with adjusted OR of 0.55. Conclusions Serum iPTH and the use of active vitamin D supplements rather than serum 25(OH)D were independently associated with the presence of MS in patients on PD.

Hypocalcaemia after total thyroidectomy: Could intact parathyroid hormone be a predictive factor for transient postoperative hypocalcemia?

Surgery ◽  
2015 ◽  
Vol 157 (2) ◽  
pp. 344-348 ◽  
Author(s):  
Alessandro Puzziello ◽  
Rita Gervasi ◽  
Giulio Orlando ◽  
Nadia Innaro ◽  
Mario Vitale ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Predictive Factor ◽  
Intact Parathyroid Hormone ◽  
Postoperative Hypocalcemia

REGULATORY HYPERPARATHYROIDISM IN A PIG BREED WITH VITAMIN D DEPENDENCY RICKETS

1979 ◽  
Vol 92 (2) ◽  
pp. 295-308 ◽  
Author(s):  
R. Wilke ◽  
J. Harmeyer ◽  
C. von Grabe ◽  
R. Hehrmann ◽  
R. D. Hesch
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Binding Assay ◽  
Clinical Symptoms ◽  
Plasma Concentrations ◽  
Fold Increase ◽  
Protein Binding Assay ◽  
Deficiency Rickets ◽  
Clinical Healing ◽  
Immunoreactive Parathyroid Hormone

ABSTRACT A radioimmunoassay for porcine parathyroid hormone has been developed and applied to measure immunoreactive parathyroid hormone (PTH) in plasma of pigs with hereditary vitamin D dependency rickets (VDDR) (pseudovitamin D deficiency rickets). Levels of 25-hydroxycholecalciferol (25-(OH)-D3) in plasma were measured by a protein binding assay. Both plasma concentrations of PTH and 25-(OH)-D3 showed an approximately 4-fold increase compared to normal pigs. PTH levels increased with duration of the disease. Daily dosing of the animals with 1–4 μg of 1,25-dihydroxycholecalciferol (1,25-(OH)2-D3) reduced PTH concentrations and resulted in clinical healing. Iv administration of 10 μg of 25-(OH)-D3/day did not alter PTH concentrations nor the clinical symptoms. The results suggest that these animals suffer from regulatory hyperparathyroidism. The metabolic defect could be due to a failure of the kidney to convert 25-(OH)-D3 to 1,25-(OH)2-D3.

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