scholarly journals Parathyroid hormone and serum calcium levels measurements as predictors of postoperative hypocalcemia in total thyroidectomy

Gland Surgery ◽  
2017 ◽  
Vol 6 (5) ◽  
pp. 428-432 ◽  
Author(s):  
Mohammed Algarni ◽  
Rajab Alzahrani ◽  
Gianlorenzo Dionigi ◽  
Al-Hakami Hadi ◽  
Haia AlSubayea
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Postoperative Hypocalcemia

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 Hypocalcaemia after Total Thyroidectomy

2020 ◽  
Vol 25 (1) ◽  
pp. 19-27
Author(s):  
Md Zahirul Islam ◽  
AF Mohiuddin Khan ◽  
Shaikh Nurul Fattah ◽  
Dipankar Lodh ◽  
Mohammad Nazrul Islam ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Malignant Disease ◽  
Cross Sectional Study ◽  
Postoperative Hypocalcemia ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Thyroid Pathology ◽  
Preoperative Serum ◽  
Female Male Female

Objective: To determine whether postoperative hypocalcemia after total thyroidectomy is more frequent in malignant disease than benign disease. Methods: This is a Cross sectional study. The sample size is 126. All the patients were selected according to the eligibility criteria by purposive sampling. Patients were analyzed for age, gender, thyroid pathology, preoperative serum calcium, postoperative serum calcium. Results: Postoperative hypocalcemia was found in 37 (29.37%) patients. Most patients were female (Male: Female= 1: 4.2). Patients having low preoperative serum calcium had developed more postoperative hypocalcemia (p<0.03). Postoperative hypocalcemia was associated with thyroid pathology (p<0.009) and age (p<0.006), not associated with sex (p<0.907). In multivariate analysis very little association between malignant disease and postoperative hypocalcemia was found (p<0.07). Conclusion: The incidence of postoperative hypocalcemia following total thyroidectomy is 29.4% that is higher than the anticipated but is comparable to other published series. For total thyroidectomy surgeons should be aware of postoperative hypocalcemia but prophylactic calcium and vitamin D supplement is not mandatory in all cases. Bangladesh J Otorhinolaryngol; April 2019; 25(1): 19-27

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

Impact of pre-operative serum 25-hydroxyvitamin D on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre: retrospective study of 246 patients

2017 ◽  
Vol 131 (10) ◽  
pp. 925-929 ◽  
Author(s):  
M Erlem ◽  
N Klopp-Dutote ◽  
A Biet-Hornstein ◽  
V Strunski ◽  
C Page
Keyword(s):  
Parathyroid Hormone ◽  
Retrospective Study ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Univariate Analysis ◽  
Multinodular Goitre ◽  
Serum Parathyroid Hormone ◽  
Single Centre ◽  
Hydroxyvitamin D ◽  
25 Hydroxyvitamin D

AbstractObjective:To determine whether pre-operative serum 25-hydroxyvitamin D has an impact on post-operative parathyroid hormone and serum calcium levels in patients undergoing total thyroidectomy for benign goitre.Methods:This single-centre, retrospective study comprised 246 unselected surgical patients who had undergone total thyroidectomy for bilateral, benign, multinodular goitre. The correlation between pre-operative serum 25-hydroxyvitamin D and post-operative serum parathyroid hormone and serum calcium was studied to determine whether low pre-operative serum 25-hydroxyvitamin D was predictive of post-operative hypocalcaemia.Results:Seventy-nine patients (32 per cent) had post-operative hypocalcaemia. Eighteen patients (7.32 per cent) experienced unintentional parathyroidectomy (1 parathyroid gland in 15 patients, 2 parathyroid glands in 3 patients). In univariate analysis, pre-operative serum 25-hydroxyvitamin D was not correlated with post-operative serum calcium (p = 0.69) or post-operative serum parathyroid hormone (p = 0.5804). Furthermore, in multivariate analysis, which took into account unintentional parathyroidectomy, no correlation was found (p = 0.33). Bilateral unintentional parathyroidectomy was statistically associated with post-operative hypocalcaemia (p = 0.032).Conclusion:Pre-operative serum 25-hydroxyvitamin D did not appear to have any impact on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre.

scholarly journals Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy

2012 ◽  
Vol 56 (3) ◽  
pp. 168-172 ◽  
Author(s):  
Felipe Augusto Brasileiro Vanderlei ◽  
Jose Gilberto Henriques Vieira ◽  
Flavio Carneiro Hojaij ◽  
Onivaldo Cervantes ◽  
Ilda Sizue Kunii ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Vitamin D Supplementation ◽  
Cutoff Value ◽  
Increased Risk ◽  
Symptomatic Hypocalcemia ◽  
Early Predictor ◽  
Selection Of

OBJECTIVE: The purpose of this study was to evaluate if the measurement of peri-operative parathyroid hormone (PTH) is able to identify patients with increased risk of developing symptoms of hypocalcemia. SUBJECTS AND METHODS: Forty patients who underwent total thyroidectomy were studied prospectively. Ionized serum calcium and PTH were measured after induction of anesthesia, one hour (PTH1) and one day after surgery (PTH24). Patients were evaluated for symptoms of hypocalcemia and treated with calcium and vitamin D supplementation as necessary. RESULTS: Symptomatic hypocalcemia developed in 16 patients. Symptomatic patients had significant lower PTH1 and greater drops in PTH levels. The selection of 12.1 ng/L as PTH1 level cutoff level divided patients with and without symptoms with 93.7% sensitivity and 91.6% specificity. The selection of 73.5% as the cutoff value for PTH decrease resulted in 91.6% sensitivity and 87.5% specificity. CONCLUSION: PTH1 levels and the drop in PTH levels are reliable predictors of developing symptomatic hypocalcemia after total thyroidectomy.

scholarly journals Timing of hypocalcemia after total or near total thyroidectomy: a prospective observational study

2020 ◽  
Vol 7 (4) ◽  
pp. 977
Author(s):  
Mohamed O. Benkhadoura ◽  
Abdulwahab M. Elbarsha ◽  
Khaled K. Elgazwi ◽  
Akrem I. Elshaikhy ◽  
Talal K. Elkhweldi ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Prospective Observational Study ◽  
Early Discharge ◽  
University Hospitals ◽  
Postoperative Hypocalcemia ◽  
The Third ◽  
Metabolic Complication ◽  
Serial Serum ◽  
Calcium Measurement

Background: Hypocalcemia after thyroidectomy is the most common metabolic complication that prolongs the hospital stay. The aim of this study was to determine timing of hypocalcemia postoperatively and determine the safest day to discharge post-total or near-total thyroidectomy patients based on serum calcium level.Methods: From October 2012 to January 2017, the medical records of 117 consecutive patients who underwent a total or near-total, completion or redo thyroidectomy for benign and malignant thyroid diseases in two university hospitals were prospectively analyzed. The serum calcium was measured preoperatively, on the morning on the first, second, third and fourth postoperative days and the postoperative day on which hypocalcemia developed was identified.Results: Of the 117 patients who underwent a total or near thyroidectomy, 36 (30.7%) developed hypocalcemia, which was transient in 34 (29%) and permanent in two (1.7%) patients. The postoperative hypocalcemia was mild in 10 (8.5%) patients, and 26 (22.2%) patients developed significant postoperative hypocalcemia. Of the 36 patients who developed hypocalcemia postoperatively, the peak incidence of hypocalcemia (72.2%) was on the first postoperative day, and by the third day serum calcium measurement detected 97.3% of patients who developed hypocalcemia.Conclusions: Postoperative serial serum calcium levels may be useful for identifying patients suitable for early discharge following total/near total thyroid surgery in hospitals that lack the facilities. Hypocalcemia peaked on the first postoperative day. However, based on serum calcium levels alone, the third postoperative day is the crucial day for deciding whether to discharge the patients.

scholarly journals MON-LB73 Incidence Rate of Post-Thyroidectomy Immediate Hypocalcemia and Its Relation to Pre-Operative Vitamin D and Parathyroid Hormone Levels

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Khadeeja Sirajuddin ◽  
Alwin Robert Asirvatham ◽  
Eman Alharbi ◽  
Fatima Sirajuddin ◽  
Nasir Al Khahtani ◽  
...  
Keyword(s):  
Vitamin D ◽  
Alkaline Phosphatase ◽  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Incidence Rate ◽  
Calcium Level ◽  
Small Sample ◽  
Postoperative Hypocalcemia ◽  
Benign Pathology ◽  
The Mean

Abstract Aim: To find out the incidence rate of post-thyroidectomy immediate hypocalcemia within 48 hours and explore the association of pre-operative vitamin D and parathyroid hormone (PTH) levels.Methods: This retrospective study was conducted among 122 patients who underwent total thyroidectomy over one year (from January 2018 to December 2018) in Prince Sultan Military Medical City, Riyadh, Saudi Arabia. After thyroidectomy, all patients were admitted and observed for at least 24-48 hours. The postoperative hypocalcemia, alkaline phosphatase (ALP), phosphate (PO4), parathyroid hormone (PTH), and vitamin D level were collected.Results: During 2018 a total of 122 (mean age 41.6±1.2 years; females 90.2%) patients underwent total thyroidectomy. The mean calcium level in the first two days was 2.07 mmol/L and 2.01 mmol/L. Most of the cases of hypocalcemia occurred on day 1 postoperatively. Hypocalcemia mainly occurs in patients with benign pathology. The level of vitamin D in those patients with benign pathology was significantly lower as compared to those with malignant pathology (49±23 vs 62±25; P=0.009). The overall mean level of vitamin D was 54.6±25 (50-150 nmol/L). Interestingly, there were no correlation between pre-operative vitamin D, PTH level and postoperative hypocalcemia. There were no statistically significant differences between postoperative hypocalcemia with other parameters except for pre-operative alkaline phosphatase which was barely positive (P=0.052).Conclusion: The outcomes of this study manifestly illustrated that a significant decline in calcium level after the surgery. In contrast to previous studies, our findings did not show a significant correlation between vitamin D level and hypocalcemia. This could be due to small sample size. Furthermore, the mean level of vitamin D in our cohort was 54 which was within the normal range. Further, well-designed randomized controlled trials with greater sample sizes are necessary to validate our findings.

DO NEAR-INFRARED INTRA-OPERATIVE FINDINGS OBTAINED USING INDOCYANINE GREEN CORRELATE WITH POST-THYROIDECTOMY PARATHYROID FUNCTION? THE ICGPREDICT STUDY

2020 ◽  
Vol 26 (9) ◽  
pp. 967-973
Author(s):  
Theodosios S. Papavramidis ◽  
Panagiotis Anagnostis ◽  
Angeliki Chorti ◽  
Ioannis Pliakos ◽  
Stavros Panidis ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Indocyanine Green ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Scoring System ◽  
Near Infrared ◽  
Eligibility Criteria ◽  
Hydroxyvitamin D ◽  
Postoperative Hypoparathyroidism ◽  
Operative Findings

Objective: Postoperative hypoparathyroidism (hypoPT) still remains a significant complication after thyroidectomy. Intra-operative imaging modalities, such as near-infrared fluorescence using indocyanine green (ICG), may assist in identifying and preserving the parathyroid glands (PGs). The purpose of this study was to test the association between the intra-operative ICG staining scoring system and 24-hour postoperative parathyroid hormone (PTH) levels, as well as its capability for intra-operative PG identification. Methods: This was a prospective study, recruiting patients scheduled for total thyroidectomy by the same surgical team, from December 2018 to April 2019. Intra-operative angiography was performed after infusion of ICG solution (5 mg). Two minutes later, images were acquired using the near-infrared system. Results: Sixty patients fulfilled the eligibility criteria. The percentage of temporary postoperative hypoPT (defined as PTH <14 pg/mL) was 11.66%. No association between intra-operative ICG staining score (expressed as the number of PGs scoring <2 per patient) and 24-hour postoperative PTH ( r = 0.011; P = .933) or serum calcium concentrations ( r = 0.127; P = .335) was observed. There was also no correlation between the location of PGs scoring ≤2 and postoperative PTH ( P = .257) or serum calcium levels ( P = .950). Moreover, with regard to secondary endpoint, ICG correctly identified PGs in 98.3% of cases. ICG score was not affected by age, gender, duration of operation, or thyroid gland pathology. No allergic reactions attributed to ICG administration were observed. Conclusion: The intra-operative ICG staining scoring system did not predict 24-hour postoperative PTH and serum calcium levels. However, this modality may assist in intra-operative PG identification during a total thyroidectomy. Abbreviations: 25(OH)D = 25-hydroxyvitamin D; hypoPT = hypoparathyroidism; ICG = indocyanine green; NIR = near-infrared; NIRF = near-infrared autofluorescence; PG = parathyroid gland; PTH = parathyroid hormone

Transient Hypocalcemia after Thyroidectomy

1993 ◽  
Vol 102 (7) ◽  
pp. 496-501 ◽  
Author(s):  
Christophe Bourrel ◽  
Bernard Uzzan ◽  
Pierre Tison ◽  
Gilles Despreaux ◽  
Bruno Frachet ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Thyroid Carcinoma ◽  
Total Thyroidectomy ◽  
Blood Supply ◽  
Serum Calcium ◽  
Thyroid Surgery ◽  
Subtotal Thyroidectomy ◽  
Total Calcium ◽  
Blood Withdrawal ◽  
Persistent Symptoms

The causes of transient hypocalcemia after thyroid surgery are not fully understood. In 95 consecutive patients undergoing total thyroidectomy (n = 30), subtotal thyroidectomy (n = 14), or hemithyroidectomy (n = 51), we serially measured total calcium, parathyroid hormone (PTH), and proteins before surgery and 6, 24, 48, 72, and 96 hours after surgery, and we calculated the corresponding ionized calcium levels. In the whole population, there was a statistically significant decrease of PTH, total calcium, and proteins at nearly every time of blood withdrawal, when compared with the preoperative levels. The PTH decreased earlier and total calcium levels were significantly lower after total thyroidectomy than after hemithyroidectomy (at 48, 72, and 96 hours). Ten patients had on 2 occasions serum calcium levels below or equal to 2 mmol/L and were defined as having severe hypocalcemia. Severe hypocalcemia was found in 8 patients after total thyroidectomy, compared with 2 after hemithyroidectomy (p < .05), and was present in 3 of the 5 patients with thyroid carcinoma, compared with 7 of the 90 patients with nonmalignant thyroid diseases (p < .01). Despite careful preservation of the parathyroid glands and their blood supply, thyroidectomy was often followed by transient hypocalcemia, the determinants of which are hypoparathyroidism and hemodilution. No patients had persistent symptoms of hypocalcemia from 2 to 3 months after surgery.

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