scholarly journals A prospective study on parathyroid hormone levels in detecting early hypocalcemia after total thyroidectomy

2017 ◽  
Vol 4 (10) ◽  
pp. 3242
Author(s):  
Sunil Kumar A. P. V. ◽  
Vinay G.
Keyword(s):  
Parathyroid Hormone ◽  
Prospective Study ◽  
Total Thyroidectomy ◽  
Calcium Supplementation ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Early Discharge ◽  
Hormone Deficiency ◽  
Hormone Levels ◽  
A Prospective Study

Background: Hypoparathyroidism and the resultant hypocalcaemia is a major cause of postoperative morbidity after total thyroidectomy with the incidence varying from 1% to 71%. This study aims to determine the incidence of parathyroid hormone deficiency as an earliest indicator for detecting hypocalcemia following total thyroidectomy.Methods: A prospective study was carried out among 50 subjects attending Department of Surgery, K. R. Hospital, Mysuru over a period of 12 months. Subjects of either sex undergoing total thyroidectomy had their serum parathyroid hormone levels tested at 1, 4, 12 and 24 hours after surgery were included in the study. Patients with poor compliance, calcium supplementation prior to surgery, coexisting parathyroid or renal pathology were excluded from the study. Descriptive statistics and Pearson correlation coefficients were used to analyse the results.Results: Among 50 study subjects, Hypocalcemia developed in 3 subjects (6%) 24 hours after thyroidectomy showing a sensitivity, specificity, negative and positive predictive value of 91%, 100%, 98% and 96% respectively.Conclusions: Parathyroid hormone levels in postoperative total thyroidectomy is an earliest indicator to detect symptomatic hypocalcemia subjects 24 hours after surgery, which prompts early administration of oral calcium replacement therapy in high risk subjects and potential safe early discharge post-operatively.

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 Parathyroid hormone assay following total thyroidectomy for early prediction of post-operative hypocalcemia

2018 ◽  
Vol 5 (3) ◽  
pp. 1100
Author(s):  
Naveen Arnepalli ◽  
Chethan Kishanchand ◽  
Balaji Jayasankar
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Hormone Level ◽  
Calcium Supplementation ◽  
Definitive Treatment ◽  
Early Prediction ◽  
Parathyroid Hormone Level ◽  
Hormone Levels ◽  
Parathyroid Hormone Assay ◽  
Hormone Assay

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.

Effect of the Oestrus Cycle on Coxofemoral Joint Laxity

1997 ◽  
Vol 10 (02) ◽  
pp. 69-74 ◽  
Author(s):  
G. K. Smith ◽  
M. G. Conzemius ◽  
H. M. Saunders ◽  
C. M. Hill ◽  
T. P. Gregor ◽  
...  
Keyword(s):  
Prospective Study ◽  
Hip Dysplasia ◽  
Joint Laxity ◽  
Hormone Levels ◽  
Oestrus Cycle ◽  
Clinically Significant ◽  
A Prospective Study

SummaryA few investigations in the 1960’s were performed to document the effect of exogenous oestrogens on development of hip dysplasia. These projects concluded that oestrogen administration caused a significant increase in hip dysplasia. Additionally, the Orthopaedic Foundation for Animals (OFA) has recommended that bitches should not have hip evaluation for certification during oestrus, due to the possibility of increased coxofemoral joint laxity. The purpose of this project was to determine if physiological fluctuations of oestrogen and progesterone throughout the oestrus cycle significantly affected coxofemoral joint laxity. Nine bitches were evaluated through a single oestrus cycle. Although significant fluctuations of oestrogen and progesterone occurred throughout the phases of the oestrus cycle, neither statistically nor clinically significant changes in coxofemoral joint laxity were documented.A prospective study documented the effect of fluctuations of hormone levels throughout the oestrus cycle on coxofemoral joint laxity in nine dogs. Although oestrogen and progesterone levels changed significantly throughout the oestrus cycle, neither statistically nor clinically significant changes in hip laxity were observed.

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.

A Prospective Study on Post-Operative Complications Following Thyroid Surgery Conducted in a Tertiary Care Hospital in Tirupati

2021 ◽  
Vol 8 (31) ◽  
pp. 2900-2905
Author(s):  
Sadhu Nagamuneiah ◽  
Gandikota Venkata Prakash ◽  
Sabitha P ◽  
Karthik Periyasamy ◽  
Sanjay Raj Kumar Reddy Madduri ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Prospective Study ◽  
Total Thyroidectomy ◽  
General Hospital ◽  
Thyroid Surgery ◽  
Complication Rate ◽  
Wound Complication ◽  
Seroma Formation ◽  
Operative Complications ◽  
A Prospective Study

BACKGROUND Thyroidectomy is a surgical procedure which is commonly performed by surgeons worldwide, but the outcome and complication rates were mainly dependent on the surgeon’s skill and experience, indication and the extent of surgery and the number of thyroid surgeries performed at that particular centre. The aim of this study was to assess the frequency of the postoperative complications after thyroid surgery in Sri Venkateswara Ramnaraian Ruiya Government General Hospital, Tirupati. METHODS A prospective study conducted on 100 patients with thyroid swelling who attended the Sri Venkateshwara Ramnaraian Ruya Government General Hospital, Tirupati. Patient age, sex, rural/urban origin, history, diagnosis, type of surgery, laboratory investigation such as complete blood, serum calcium, thyroid function test, us culture and sensitivity test in wound infections and indirect laryngoscopy for all pre-operative patients and postoperative voice change patients. Outcomes recorded as a complication of thyroid surgery within one week. RESULTS Totally 100 patients were enrolled in the study. Thyroid enlargement was more common in females (F: M =5.6:1) presenting in 3rd and 4th decades mostly with the mean age and standard deviation were 42.92 years and 13.097 years respectively. Total thyroidectomy was the most common procedure performed (44 %) followed by hemithyroidectomy (31 %), subtotal thyroidectomies (29 %) and near total thyroidectomy (5 %). On histopathological examination most common finding was multinodular goiter (54 %) followed by nodular goiter (33 %) and malignancies (10 %). The overall postoperative complication rate was 47 %. The most common postoperative complications after thyroidectomies were seroma formation in wound complication (27 %), followed by hypocalcemia (11 %), recurrent laryngeal nerve (RLN) injury (3 %), and surgical site infection (2 %). Majority of these complications were found to be associated with total thyroidectomy, female population, and in patients with age more than 30 years. CONCLUSIONS Seroma formation in wound complication is the commonest post thyroidectomy complication. Female gender, old age, and extensive thyroid surgery were associated with increased complication rate. KEYWORDS Post-Operative Complications, Thyroid Surgery

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.

Tele-glaucoma versus clinical evaluation: The New Jersey Health Foundation Prospective Clinical Study

2019 ◽  
Vol 26 (9) ◽  
pp. 536-544 ◽  
Author(s):  
Subhashini Chandrasekaran ◽  
William Kass ◽  
Loka Thangamathesvaran ◽  
Nicole Mendez ◽  
Peter Khouri ◽  
...  
Keyword(s):  
Pearson Correlation ◽  
Corneal Thickness ◽  
Correlation Coefficients ◽  
Retinal Nerve Fibre Layer ◽  
Posterior Pole ◽  
Fundus Photography ◽  
Prospective Clinical Study ◽  
Ganglion Cell Complex ◽  
Complex Data ◽  
A Prospective Study

Introduction Glaucoma, the second most common cause of blindness, is normally detected in clinic. With technological improvements, tele-glaucoma exams can identify these changes off-site. The quality of tele-glaucoma exams needs to be compared with that of traditional exams. This study’s purpose was to validate the tele-glaucoma programme, which allows a physician comprehensive access to patients’ data, by comparing results to clinical examinations. Methods A prospective study of 107 subjects evaluated in clinic and then tele-glaucoma stations, which consisted of non-mydriatic fundus photography, puff-tonometry, auto-refraction and Optical Coherence Tomography (OCT). The OCT captured central corneal thickness, angle anatomy, cup-to-disc ratio (CDR), retinal nerve fibre layer distribution and posterior-pole ganglion cell complex data. Results Intraocular pressure (IOP) comparisons between clinical and tele-glaucoma exams had strong positive Pearson correlation coefficients (0.8248 OD, 0.8672 OS). Strong positive correlations were seen for CDR (0.7835 OD, 0.8082 OS) as well as diagnosis (glaucoma, no glaucoma or glaucoma suspect). A moderate positive correlation was seen for return to clinic time (RTC). Tele-glaucoma had an average lower RTC (2.7 vs 3.9 months). Tele-glaucoma was more likely to elicit a non-glaucomatous diagnosis not found in clinic vs a diagnosis found only in clinic (18% vs 5% of subjects). Discussion Tele-glaucoma allows for detecting glaucoma remotely. These advancements alleviate patient difficulties with obtaining adequate glaucoma screenings and helps ophthalmologists triage patients with more severe pathology. Our study indicates that our tele-glaucoma protocol is comparable to a clinical exam in its ability to detect glaucoma. Further studies will be needed for off-site testing and transferring data separately for analysis.

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