scholarly journals Measurement of serum intact parathyroid hormone concentration 1 day after total thyroidectomy to assess risk of permanent hypoparathyroidism

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092719
Author(s):  
Jianwei Zheng ◽  
Shuyan Cai ◽  
Huimin Song ◽  
Yunlei Wang ◽  
Xiaofeng Han ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Intact Parathyroid Hormone ◽  
Permanent Hypoparathyroidism ◽  
Clinical Value ◽  
Predictive Risk Factor ◽  
Patients At Risk ◽  
Ipth Concentration

Objective This study was performed to assess the clinical value of measuring the intact parathyroid hormone (iPTH) concentration 1 day after total thyroidectomy to estimate the occurrence of permanent hypoparathyroidism (pHPP). Methods Data of 546 patients who underwent total thyroidectomy from February 2008 to December 2018 were retrospectively analyzed. Calcium and iPTH concentrations were collected preoperatively and at 1 day and 6 months postoperatively. Logistic regression was used to analyze the correlation between clinical indexes and postoperative pHPP. Results Of the 546 patients, 22 (4.03%) developed pHPP. Multivariate analysis showed that the iPTH and serum calcium concentrations measured 1 day after surgery were independent predictors of the risk of pHPP. An iPTH concentration of 5.51 pg/mL measured 1 day postoperatively was used as the cut-off value, and the area under the curve was 0.956. The risk of pHPP was identified with a sensitivity of 100%, specificity of 85.1%, positive predictive value of 22%, and negative predictive value of 100%. Conclusions The iPTH concentration measured 1 day after total thyroidectomy is closely related to the occurrence of pHPP postoperatively and is an independent predictive risk factor. The postoperative iPTH concentration can be helpful in identifying patients at risk for developing pHPP.

Intact Parathyroid Hormone Measurement at 24 Hours after Thyroid Surgery: Predictive Value to Permanent Hypoparathyroidism

2011 ◽  
pp. P2-687-P2-687
Author(s):  
Teresa Julian ◽  
Maria Luisa Granada ◽  
Jose Maria Balibrea ◽  
Pau Moreno ◽  
Antonio Alastrue ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Thyroid Surgery ◽  
Predictive Value ◽  
Intact Parathyroid Hormone ◽  
Permanent Hypoparathyroidism

scholarly journals A Single Parathyroid Hormone Measurement Two Hours after a Thyroidectomy Reliably Predicts Permanent Hypoparathyroidism

2020 ◽  
pp. 145749692091366
Author(s):  
D. Palmhag ◽  
J. Brydolf ◽  
J. Zedenius ◽  
R. Bränström ◽  
I.-L. Nilsson
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
Permanent Hypoparathyroidism ◽  
Operating Characteristics ◽  
Predictive Values ◽  
Entire Cohort ◽  
Benign Thyroid Disorders

Introduction: Hypoparathyroidism is the most common complication following thyroidectomy, and various algorithms for early detection have been suggested. The aim of this study was to evaluate the predictive value of measuring the parathyroid hormone level 2 h after thyroidectomy and whether determination of the perioperative decline in parathyroid hormone added diagnostic value. Methods: Patients subjected to thyroidectomy for benign thyroid disorders were analyzed in (1) a retrospective register-based study (366 consecutive patients treated during 2015–2016) and (2) a prospective observational study (39 patients treated during 2018). Optimal cut-off values for postoperative parathyroid hormone and perioperative decline (%) in parathyroid hormone were determined by receiver operating characteristics and area under the curve. Sensitivity, specificity, positive and negative predictive values were calculated using cross tabulation. Results: The prevalence of hypoparathyroidism the first day after thyroidectomy was higher among patients treated for hyperthyroidism (30% vs 20%; P = 0.03). The optimal cut-off level for postoperative parathyroid hormone was 1.1 pmol/L (area under the curve = 0.887, 95% confidence interval: 0.839–0.934; positive predictive value: 88%, negative predictive value: 93%) for the entire cohort. When the groups were analyzed separately, the optimal cut-off was 1.05 for the non-hyperfunctioning group and 1.55 pmol/L for the group with hyperthyroidism. Twelve months after thyroidectomy, 3% were defined as having permanent hypoparathyroidism. Measurement of parathyroid hormone decline added diagnostic value for one patient with preoperative parathyroid-hormone-elevation associated with vitamin D deficiency. Conclusion: For patients with vitamin D sufficiency, the diagnostic accuracy of a single measurement of parathyroid hormone 2 h after thyroidectomy is an excellent indicator for predicting transient hypoparathyroidism.

Serum levels of intact parathyroid hormone on the first day after total thyroidectomy as predictor of permanent hypoparathyroidism

2019 ◽  
Vol 66 (3) ◽  
pp. 195-201
Author(s):  
Pablo Calvo Espino ◽  
José Ángel Rivera Bautista ◽  
Mariano Artés Caselles ◽  
Javier Serrano González ◽  
Arturo García Pavía ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Serum Levels ◽  
Intact Parathyroid Hormone ◽  
Permanent Hypoparathyroidism

INCIDENCE, RISK FACTORS, AND CLINICAL IMPLICATIONS OF DELAYED HYPOPARATHYROIDISM ON POSTOPERATIVE DAY TWO FOLLOWING TOTAL THYROIDECTOMY FOR PAPILLARY THYROID CARCINOMA

2020 ◽  
Vol 26 (7) ◽  
pp. 768-776
Author(s):  
Seung Taek Lim ◽  
Ye Won Jeon ◽  
Hongki Gwak ◽  
Young Jin Suh
Keyword(s):  
Risk Factors ◽  
Parathyroid Hormone ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Total Thyroidectomy ◽  
Significant Risk ◽  
Clinical Implications ◽  
Intact Parathyroid Hormone ◽  
Permanent Hypoparathyroidism ◽  
Papillary Thyroid

Objective: This study aimed to investigate the incidence rates, risk factors, and clinical implications of delayed hypoparathyroidism on postoperative day 2 (POD-2) after total thyroidectomy in patients with papillary thyroid carcinoma. Methods: This study included 410 patients with normal serum intact parathyroid hormone (iPTH) and calcium levels on postoperative day 1 (POD-1) who were classified into 2 groups according to the presence or absence of delayed hypoparathyroidism on POD-2. Results: Of the 410 patients, 98 experienced delayed hypoparathyroidism on POD-2 (23.9%). The significant risk factors for delayed hypoparathyroidism on POD-2 included female gender, age older than 45 years, central lymph node dissection, increased number of excised lymph nodes, and low POD-1 versus preoperative iPTH ratios. Additionally, delayed hypoparathyroidism on POD-2 was found to be a significant risk factor for hypocalcemia on POD-2 and permanent hypoparathyroidism. Conclusion: Prophylactic calcium supplementation and long-term surveillance for permanent hypoparathyroidism should be considered in patients with risk factors for delayed hypoparathyroidism on POD-2. Abbreviations: CI = confidence interval; iPTH = intact parathyroid hormone; OR = odds ratio; POD-1 = postoperative day 1; POD-2 = postoperative day 2; PTC = papillary thyroid carcinoma; ROC = receiver operating characteristic

scholarly journals Next-day Parathyroid Hormone as a Predictor of Post-thyroidectomy Hypocalcemia

2016 ◽  
Vol 8 (3) ◽  
pp. 203-207 ◽  
Author(s):  
MJ Paul ◽  
Thomas V Paul ◽  
Deepak T Abraham ◽  
Anish Cherian
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Predictive Value ◽  
Calcium Supplementation ◽  
Early Discharge ◽  
Tertiary Hospital ◽  
Vitamin D Supplementation ◽  
Postoperative Hypocalcemia ◽  
Parathyroid Dysfunction ◽  
Pth Level

ABSTRACT Aims Total thyroidectomy is significantly complicated by parathyroid dysfunction and hypocalcemia. These aspects impact the decision regarding the timing of discharge and quantum of calcium supplementation required. Therefore, we aimed at evaluating the accuracy of next-day parathyroid hormone (PTH) level as a predictor of post-thyroidectomy hypocalcemia. Secondly, we aimed at establishing our institution's postoperative PTH level, which can accurately predict the development of post-thyroidectomy hypocalcemia to help us ensure the safe and early discharge of patients. Materials and methods A prospective observational study of 50 continuous patients undergoing thyroidectomy was conducted at a tertiary hospital in South India. Postoperative blood samples were collected for estimation of PTH, calcium, albumin, and phosphorous. The data were collated and results analyzed using Stata I/C 10.1. Results A total of 30% (15/50) of the patients had postoperative hypocalcemia (serum calcium <8 mg/dL). Postoperative PTH was low (<8 pg/mL) in 40% (20/50) of patients. There was a significant association between PTH < 8 pg/mL and the presence of postoperative hypocalcemia (p = 0.029). The area under the receiver operating characteristic (ROC) curve was 0.7, and a next-day PTH of <6 pg/mL showed the highest sensitivity and specificity (83 and 60% respectively) for the development of postoperative hypocalcemia, with a positive predictive value (PPV) and negative predictive value (NPV) of 83 and 60 respectively. Conclusion The PTH assessment performed the day after surgery is an acceptable test to predict post-thyroidectomy hypocalcemia; PTH <6 pg/mL can be used as our institution's cutoff value. Department protocols for calcium and vitamin D supplementation following total thyroidectomy may be formulated based on the appropriately timed local postoperative PTH value to assist safe and early discharge of patients. Clinical significance Discharge protocols for patients undergoing thyroidectomy may be formulated based on the postoperative PTH values, thus enabling safe and early discharge of patients. How to cite this article Cherian AJ, Ramakant P, Paul TV, Abraham DT, Paul MJ. Next-day Parathyroid Hormone as a Predictor of Post-thyroidectomy Hypocalcemia. World J Endoc Surg 2016;8(3):203-207.

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

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

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 Convolutional Neural Network for Breast and Thyroid Nodules Diagnosis in Ultrasound Imaging

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Xiaowen Liang ◽  
Jinsui Yu ◽  
Jianyi Liao ◽  
Zhiyi Chen
Keyword(s):  
Predictive Value ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Diagnostic Efficiency ◽  
Clinical Value ◽  
Data Set ◽  
Multiple Organs ◽  
Significant Difference ◽  
Segmented Images ◽  
The Impact

Objective. The incidence of superficial organ diseases has increased rapidly in recent years. New methods such as computer-aided diagnosis (CAD) are widely used to improve diagnostic efficiency. Convolutional neural networks (CNNs) are one of the most popular methods, and further improvements of CNNs should be considered. This paper aims to develop a multiorgan CAD system based on CNNs for classifying both thyroid and breast nodules and investigate the impact of this system on the diagnostic efficiency of different preprocessing approaches. Methods. The training and validation sets comprised randomly selected thyroid and breast nodule images. The data were subgrouped into 4 models according to the different preprocessing methods (depending on segmentation and the classification method). A prospective data set was selected to verify the clinical value of the CNN model by comparison with ultrasound guidelines. Diagnostic efficiency was assessed based on receiver operating characteristic (ROC) curves. Results. Among the 4 models, the CNN model using segmented images for classification achieved the best result. For the validation set, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the curve (AUC) of our CNN model were 84.9%, 69.0%, 62.5%, 88.2%, 75.0%, and 0.769, respectively. There was no statistically significant difference between the CNN model and the ultrasound guidelines. The combination of the two methods achieved superior diagnostic efficiency compared with their use individually. Conclusions. The study demonstrates the probability, feasibility, and clinical value of CAD in the ultrasound diagnosis of multiple organs. The use of segmented images and classification by the nature of the disease are the main factors responsible for the improvement of the CNN model. Moreover, the combination of the CNN model and ultrasound guidelines results in better diagnostic performance, which will contribute to the improved diagnostic efficiency of CAD systems.

scholarly journals Intraoperative serum parathyroid hormone level is an indicator of hypocalcaemia in total thyroidectomy patients

2013 ◽  
Vol 38 (3) ◽  
pp. 84-89 ◽  
Author(s):  
MS Islam ◽  
T Sultana ◽  
D Paul ◽  
AHMZ Huq ◽  
AA Chowdhury ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Predictive Value ◽  
Clinical Pathology ◽  
High Sensitivity ◽  
Intraoperative Pth ◽  
Serum Pth ◽  
Sensitivity Specificity ◽  
Postoperative Hypocalcaemia ◽  
Pth Level

Postoperative hypocalcaemia is the most frequent and common complication after total thyroidectomy. It is necessary to diagnose or to predict hypocalcaemia immediately after total thyroidectomy for minimizing complications. A prospective observational study was carried out in the Department of Clinical Pathology in collaboration with Department of Microbiology & Immunology, Department of Surgery, Department of Otolaryngology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Department of Otolaryngology, Dhaka Medical College & Hospital (DMC&H), Dhaka, during the period of September 2010 to August 2011 to evaluate intraoperative (20 minutes after total thyroidectomy) parathyroid hormone (PTH) measurement as a predictor of post thyroidectomy hypocalcaemia. Total 65 patients were enrolled in this study those came for total thyroidectomy. Postoperative hypocalcaemia developed in 25 cases. Intraoperative PTH was assessed and significant correlation was found between intraoperative PTH level and development of hypocalcaemia. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of intraoperative serum PTH for prediction of post total thyroidectomy hypocalcaemia were 84.0%, 85.0%, 84.6%, 77.8%, and 89.5% respectively. Because of the high sensitivity, specificity and accuracy of intraoperative serum PTH of this study, the early prediction of hypocalcaemia could be made by single assay of intraoperative serum PTH level at 20 minutes after total thyroidectomy. DOI: http://dx.doi.org/10.3329/bmrcb.v38i3.14331 Bangladesh Med Res Counc Bull 2012; 38(3): 84-89 (December)

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