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 < 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 < 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 < 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 Intraoperacinės parathormono koncentracijos matavimas pooperaciniam hipoparatiroidizmui numatyti po visiškosios tiroidektomijos

2007 ◽  
Vol 5 (4) ◽  
pp. 0-0
Author(s):  
Algirdas Šlepavičius ◽  
Virgilijus Beiša
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Predictive Value ◽  
University Hospital ◽  
Endocrine Surgery ◽  
Iopth Level ◽  
Postoperative Hypoparathyroidism ◽  
Symptomatic Hypocalcemia ◽  
The Mean ◽  
Intraoperative Parathyroid Hormone

Algirdas Šlepavičius1,  Virgilijus Beiša21 Klaipėdos universitetinės ligoninės Pilvo ir endokrininės chirurgijos skyrius,Liepojos g. 41, LT-92288 KlaipėdaEl paštas: [email protected] Vilniaus universiteto ligoninės Santariškių klinikų Pilvo chirurgijos ir gastroenterologijos klinika,Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Įvadas / tikslas Intaktinio intraoperacinio parathormono (IOPTH) koncentracija kaip prieskydinių liaukų funkcijos rodiklis dažnai nustatoma operuojant nuo pirminio ir antrinio hiperparatiroidizmo. Šio perspektyviojo tyrimo tikslas – išanalizuoti IOPTH galimybes pooperaciniam hipoparatiroidizmui prognozuoti skydliaukės chirurgijoje. Ligoniai ir metodai Klaipėdos ligoninės Pilvo ir endokrininės chirurgijos skyriuje ir Vilniaus universiteto ligoninės Santariškių klinikų Pilvo chirurgijos centre nuo 2005 m. birželio 1 d. iki 2006 m. sausio 1 d. 89 ligoniams, praėjus 10 minučių po tiroidektomijos, buvo tiriama IOPTH koncentracija kraujyje. Kalcio koncentracija kraujyje buvo tikrinama praėjus 24, 48 ir 72 val. po operacijos. Visi operuotieji suskirstyti į dvi grupes: ligoniai, kuriems po tiroidektomijos nebuvo hipoparatiroidizmo reiškinių (A grupė n = 78), ir ligoniai, kuriems po tiroidektomijos išsivystė hipoparatiroidizmo požymiai (B grupė n = 11). Palyginti abiejų gupių ligonių IOPTH ir kalcio koncentracijos kraujyje skirtumai bei hipoparatiroidizmo klinikinės išraiškos priklausomybė nuo IOPTH ir kalcio koncentracijos kraujyje. Rezultatai Iš 89 ligonių vienuolikai (12,4%) po visiškosios tiroidektomijos išsivystė pooperacinis hipoparatiroidizmas. Simptomai pasireiškė nuo 24 val. iki 52 val. po operacijos. Ligonių, kuriems po operacijos išsivystė hipoparatiroidizmo klinika, vidutinė IOPTH koncentracija kraujyje buvo daug mažesnė (7,2 ± 1,32 pg/ml) nei tų, kuriems hipoparatiroidizmo klinikos nebuvo (42 ± 2,79 pg/ml) (p < 0,05). Po tiroidektomijos mažesnė nei 10 pg/ml IOPTH koncentracija kraujyje turėjo 90,9% jautrumą ir 100% specifiškumą prognozuojant pooperacinį hipoparatiroidizmą. Teigiama numatymo vertė 100%, neigiama numatymo vertė 90%. Išvada Jei IOPTH koncentracija kraujyje praėjus 10 minučių nuo skydliaukės pašalinimo yra mažesnė nei 10 pg/ml, galime prognozuoti pooperacinį hipoparatiroidizmą. IOPTH tyrimas klinikinėje praktikoje leidžia laiku pradėti gydyti rizikos grupės ligonius kalcio preparatais, o jei reikia – ir vitaminu D, o ne rizikos grupės ligonius būtų galima gerokai anksčiau išleisti į namus. Pagrindiniai žodžiai: intraoperacinis parathormono matavimas, visiškoji tiroidektomija, pooperacinis hipoparatiroidizmas Intraoperative parathyroid hormone level monitoring for predicting postoperative hypoparathyroidism after total thyroidectomy Algirdas Šlepavičius1,  Virgilijus Beiša21 Klaipėda University Hospital, Department of Abdominal and Endocrine Surgery,Liepojos str. 41, LT-92288 Klaipėda, LithuaniaE-mail: [email protected] Kaunas University of Medicine,Insitute for Biomedical Research,Eivenių g. 4, LT-50009 Kaunas, LithuaniaE-mail: [email protected] Background / objective Intraoperative parathyroid hormone (IOPTH) levels are usually not monitored during thyroidectomy, although they are widely used during parathyroidectomy as an indicator of parathyroid gland function.This prospective study evaluated the occurrence of hypoparathyroidism after total thyroidectomy and the use of IOPTH levels for predicting the postoperative hypoparathyroidism and the need for postoperative vitamin D and Ca supplementation. Patients and methods Eighty nine patients underwent total thyroidectomy at the Department of Abdominal and Endocrine Surgery of Klaipėda University Hospital and at the Abdominal Center of Vilnius University Hospital Santariškių Klinikos from 01-06-2005 to 01-01-2006. The IOPTH was measured 10 min after thyroidectomy. Postoperative calcium levels were monitored 24, 48 and 72 hours after surgery. IOPTH levels were correlated with postoperative calcium levels and clinical symptoms of hypocalcemia. Patients with symptomatic hypocalcemia are compared with asymptomatic patients. Results Twelve patients developed hypocalcemia after thyroidectomy. The onset of symptomatic hypocalcemia ranged from 24 to 52 hours. The mean IOPTH level (7.2 ± 1.32 pg/ml) in patients who developed symptomatic hypocalcemia was significantly lower than the mean IOPTH level (42 ± 2.79 pg/ml) in patients without symptoms (p < 0.05). An IOPTH level less than 10 pg/ml had a sensitivity of 90%, a specifity of 100%, a positive predictive value of 100%, and a negative predictive value of 90% for the development of symptomatic hypocalcemia. Conclusion An IOPTH level less than 10 pg/ml 10 minutes after total thyroidectomy is a strong predictor of hypoparathyroidism. The incorporation of the IOPTH assay in the management of thyroid diseases is recommended to prevent and prospectively treat symptomatic hypocalcemia. Key words: Intraoperative parathyroid hormone monitoring, postoperative hypoparathyroidism, total thyroidectomy

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.

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 Pre-operative Localisation of the Parathyroid Glands in Secondary Hyperparathyroidism: A Retrospective Cohort Study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Takahisa Hiramitsu ◽  
Toshihide Tomosugi ◽  
Manabu Okada ◽  
Kenta Futamura ◽  
Makoto Tsujita ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cohort Study ◽  
Parathyroid Hormone ◽  
Secondary Hyperparathyroidism ◽  
Retrospective Cohort ◽  
Parathyroid Glands ◽  
Imaging Modalities ◽  
Intact Parathyroid Hormone ◽  
Intact Pth ◽  
Persistent Hyperparathyroidism

Abstract Complete parathyroidectomy (PTx) is essential during total PTx for secondary hyperparathyroidism (SHPT) to prevent recurrent and persistent hyperparathyroidism. Pre-operative imaging evaluations, including computed tomography (CT), ultrasonography (US), and Tc-99m sestamibi (MIBI) scans, are commonly performed. Between June 2009 and January 2016, 291 patients underwent PTx for SHPT after pre-operative evaluations involving CT, US, and MIBI scans, and the diagnostic accuracies of these imaging modalities for identifying the parathyroid glands were evaluated in 177 patients whose intact parathyroid hormone (PTH) levels were <9 pg/mL after the initial PTx. Additional PTx procedures were performed on 7 of 114 patients whose intact PTH levels were >9 ng/mL after PTx, and the diagnostic validities of the imaging modalities for the remnant parathyroid glands were evaluated. A combination of CT, US, and MIBI scans achieved the highest diagnostic accuracy (75%) for locating bilateral upper and lower parathyroid glands before initial PTx. The accuracies of CT, US, and MIBI scans with respect to locating remnant parathyroid glands before additional PTx were 100%, 28.6%, and 100%, respectively. A combination of CT, US, and MIBI scans is useful for initial PTx for SHPT, and CT and MIBI scans are useful imaging modalities for additional PTx procedures.

scholarly journals Outcome of supplementation of vitamin D on intact parathyroid hormone level in chronic kidney disease patients

2019 ◽  
Vol 8 (2) ◽  
pp. 51-54
Author(s):  
Laxman Prasad Adhikary ◽  
Aarjan Khanal
Keyword(s):  
Chronic Kidney Disease ◽  
Parathyroid Hormone ◽  
Kidney Disease ◽  
Hormone Level ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Intact Parathyroid Hormone ◽  
Parathyroid Hormone Level ◽  
Modifiable Factors ◽  
The Mean

Background: Secondary hyperparathyroidism is present in majority of patients with estimated glomerular filtrate rate less than 60 mL/min/1.73 m2. Sustained elevated parathyroid hormone level can cause osteitis-fibrosa-cystica, fracture, hypercalcemia, hyperphosphatemia, and calciphylaxis. Kidney Disease Improving Global Outcome guidelines for Chronic Kidney Disease Mineral and Bone Disorder 2017 recommends treatment with calcitriol or vitamin D analogue if parathyroid hormone level is progressively increasing and remains persistently above the upper limit despite correction of modifiable factors. Objectives: The objective of this study was to determine the mean change in intact parathyroid hormone aftercalcitriol supplementation in patients with chronic kidney disease (stage 3 to 5). Methodology: This prospective observational study enrolled 92 patients with chronic kidney disease stage 3 to 5, not under maintenance hemodialysis. Patients who had intact parathyroid hormone level more than 200 pg/ml, serum phosphate level less than 4.5 mg/dl and corrected serum calcium less than 9.5 mg/dl were selected for the study. They were supplemented with oral calcitriol 0.25μg thrice weekly for three months and intact parathyroid hormone level was measured after three months. Results: Mean intact parathyroid hormone level before supplementation was 332.91 ± 96.046pg/ml and after three months of supplementation with calcitriol was 176.49 ±53.764pg/ml. This finding was statistically significant (Correlation: 0.471, p-value less than 0.05). Thus, supplementation of calcitriol reduced the mean intact parathyroid hormone level in the chronic kidney disease patients in our study. Conclusion: Calcitriol supplementation seems to be an effective measure to reduce intact parathyroid hormone level in chronic kidney disease patients when it remains persistently high despite correction of modifiable factors.

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

A postoperative parathyroid hormone-based algorithm to reduce symptomatic hypocalcemia following completion/total thyroidectomy: A retrospective analysis of 591 patients

Surgery ◽  
2018 ◽  
Vol 164 (4) ◽  
pp. 746-753 ◽  
Author(s):  
Ioanna G. Mazotas ◽  
Tina W.F. Yen ◽  
Jiyoon Park ◽  
Ying Liu ◽  
Daniel C. Eastwood ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Retrospective Analysis ◽  
Symptomatic Hypocalcemia

scholarly journals Intraoperative Autofluorescence and Indocyanine Green Angiography for the Detection and Preservation of Parathyroid Glands

2020 ◽  
Vol 9 (3) ◽  
pp. 830 ◽  
Author(s):  
Marco Stefano Demarchi ◽  
Wolfram Karenovics ◽  
Benoît Bédat ◽  
Frédéric Triponez
Keyword(s):  
Thyroid Surgery ◽  
Near Infrared ◽  
Infrared Imaging ◽  
Parathyroid Tissue ◽  
Parathyroid Glands ◽  
Endocrine Surgery ◽  
Near Infrared Imaging ◽  
Postoperative Hypoparathyroidism

Fluorescence imaging is a well-known method for both the in vivo and in vitro identification of specific cells or tissues. This imaging tool is gaining importance in the intraoperative detection and preservation of parathyroid glands during endocrine surgery owing to the intrinsic properties of parathyroid tissue. The aim of this paper is to provide an overview of the basics of the technology, its history, and the recent surgical intraoperative applications of near-infrared imaging methods. Moreover, a literature review of the utilization of fluorescence devices in thyroid surgery suggests that the use of near-infrared imaging seems to be beneficial in reducing postoperative hypoparathyroidism, which is one of the most frequent complications of thyroid surgery.

A Cohort Study Assessing the Association Between Body Composition Parameters and Symptomatic Hypocalcemia After Total Thyroidectomy

2020 ◽  
pp. 000313482097957
Author(s):  
Suleyman U. Celik ◽  
Can Konca ◽  
Volkan Genc
Keyword(s):  
Body Composition ◽  
Total Thyroidectomy ◽  
Clinical Symptoms ◽  
The Body ◽  
Postoperative Hypocalcemia ◽  
Parathyroid Autotransplantation ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Symptomatic Hypocalcemia ◽  
The Relationship

Background Postoperative hypocalcemia is one of the major concerns following thyroidectomy and the most frequent cause of prolonged hospital stay. The aim of this study was to evaluate the relationship between body composition parameters and symptomatic hypocalcemia following total thyroidectomy. In addition, the effects of disease- and patient-related factors on hypocalcemia were investigated. Methods A total of 144 patients were prospectively included between March 2014 and September 2017. Patients were divided into 2 groups according to the presence or absence of clinical symptoms of hypocalcemia. Subsequently, the relationship between body composition parameters and hypocalcemia was evaluated. Results Postoperative hypocalcemia-related symptoms occurred in 28 patients (19.4%). Permanent hypocalcemia was not encountered in any patient. Patients with hypocalcemic symptoms were more likely to have nodules ≥40 mm (39.3% vs. 17.2%, P = .011), retrosternal goiters (25.0% vs. 7.8%, P = .017), central lymph node dissection (LND) (32.1% vs. 11.2%, P = .015), and parathyroid autotransplantation (28.6% vs. 3.4%, P < .001) than those without symptoms. However, no differences were observed in the body composition parameters between symptomatic and asymptomatic patients. On multivariate analysis, lower preoperative intact parathyroid hormone (iPTH) levels (odds ratios (ORs) .96, 95% confidence intervals (CIs) .93-.99), the presence of retrosternal goiters (OR 10.26, 95% CI 2.23-47.14), central LND (OR 16.05, 95% CI 3.90-66.07), and parathyroid autotransplantation (OR 36.22, 95% CI 6.76-194.13) predicted hypocalcemia. Discussion This study demonstrates that patients with lower preoperative iPTH levels, retrosternal goiters, central LND, and parathyroid autotransplantation are at an increased risk of developing clinical symptoms of hypocalcemia. Body composition parameters have no effect on the incidence of hypocalcemia after total thyroidectomy.

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