scholarly journals Role of Intact Parathyroid Hormone (iPTH) Level as an Early Predictor of Postoperative Hypocalcemia after Total Thyroidectomy for Simple Multi-Nodular Goiter

2019 ◽  
Vol 21 (2) ◽  
pp. 144-159
Author(s):  
Mohamed KF Hamed ◽  
Amr H Afifi
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Nodular Goiter ◽  
Intact Parathyroid Hormone ◽  
Postoperative Hypocalcemia ◽  
Ipth Level ◽  
Early Predictor

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

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 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 Role of Parathyroid Hormone Assay and Bedside Ultrasound in the Emergency Department in Differentiating Acute Kidney Injury from Chronic Kidney Disease: A Systematic Review

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Deepali Junnarkar Roy ◽  
Shrikant Digambarrao Pande ◽  
Zhong Hong Liew ◽  
Debajyoti Roy
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Emergency Department ◽  
Acute Kidney Injury ◽  
Parathyroid Hormone ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Bedside Ultrasound ◽  
Ipth Level

Introduction. It is not uncommon for patients without preceding history of kidney disease to present to the Emergency department with renal failure. The absence of prior medical records or renal imaging presents a diagnostic challenge. Elevated parathyroid hormone levels or echogenic contracted kidneys on ultrasound are known to point to a diagnosis of chronic kidney disease. The literature in this regard is surprisingly limited. The objective of this study is to assess the role of intact parathyroid (iPTH) blood level and bedside ultrasound in differentiating acute kidney injury from chronic kidney disease. Methods. A systematic review which included a literature search of 3 databases, PubMed, Embase, and Cinahl (R) as also secondary sources, was done. The inclusion criteria evaluated studies which evaluated iPTH or bedside ultrasound in differentiating acute kidney injury from chronic kidney disease. We excluded studies which used other laboratory biomarkers like neutrophil gelatin associated lipocalin (NGAL) or carbamylated haemoglobin. A total of 2256 articles were identified. After screening, the relevant articles were reviewed, and an assessment of their methodological quality was made based on the CASP: Critical Appraisals Skill Programme. Results. Of the 2256 articles identified, after screening, only 5 were identified as relevant. Conclusions. An elevated parathyroid hormone level and echogenic contracted kidneys on bedside ultrasound in the Emergency department can help differentiate acute kidney injury from chronic kidney disease. This differentiation helps decide need for admission as well as further management. Although iPTH level may also rise in acute kidney injury, the value (2.5 times normal) can discriminate it from chronic kidney disease.

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).

Role of preoperative intact parathyroid hormone levels in predicting the likelihood of multiglandular disease in primary hyperparathyroidism

Head & Neck ◽  
2010 ◽  
Vol 33 (4) ◽  
pp. 543-546
Author(s):  
Emad Kandil ◽  
Kathryn A. Carson ◽  
Anthony P. Tufaro ◽  
Obai Abdullah ◽  
Haytham Alabbas ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Intact Parathyroid Hormone ◽  
Multiglandular Disease ◽  
Hormone Levels

scholarly journals Causes of hypocalcemia after thyroid surgery

2020 ◽  
Vol 101 (2) ◽  
pp. 206-211
Author(s):  
A F Hummatov ◽  
A H Abbasov ◽  
A K Ismayilov ◽  
E M Gasymov
Keyword(s):  
Total Thyroidectomy ◽  
Nodular Goiter ◽  
Early Postoperative Period ◽  
Test Results ◽  
Postoperative Hypocalcemia ◽  
Parathyroid Autotransplantation ◽  
The Third ◽  
Repeated Surgery ◽  
Permanent Hypocalcemia ◽  
Median Test

Aim. To identify the causes affecting hypocalcemia and its frequency of causing after thyroidectomy. Methods. The study included 402 patients after thyroidectomy, 361 (89.8%) women and 41 (10.2%) men, for the period 20152019. The patients were between the ages of 14 and 77 years (average 4527.2 years). Patients were tested for the presence of hyperthyroidism, the volume of tissue removed and type of thyroidectomy, presence of repeated thyroid operations and accidental parathyroidectomy, the results of parathyroid autotransplantation and pathohistological reports. To determine the effect of these factors on hypocalcemia, patients were divided into three groups. The first group included patients (n=51, 12.7%) were underwent surgery for Graves disease, the second (n=335, 83.3%) for nodular goiter, and the third (n=16, 4%) for recurrent goiter. Statistical data analysis was performed with IBM SPSS 16.0. The results were analyzed by one-way analysis of variance or KruskalWallis test and the median test. Results were considered statistically significant at p 0.05 (two-sided criterion). Results. In the early postoperative period, 20 (5%) of 402 patients had hypocalcemia, of which 12 (3%) had transient hypocalcemia, and 8 (2%) had permanent hypocalcemia. Postoperative hypocalcemia was detected in 9 (17.6%) patients the first group, 8 (2.4%) patients in the second group, and 3 (18.8%) patients of the third group. Patients hypocalcemia was characterized based on the types of underwent operations as follows: in 14 (5.3%; p 0.05) patients after total thyroidectomy, in 1 (3.2%) patient after close to total thyroidectomy, in 1 (16.7%) patient after total thyroidectomy with central lymphatic dissection, in 1 (20%) patient after total thyroidectomy with central and lateral lymphatic dissection, in 3 (18.8%) patients after repeated surgery. Postoperative hypocalcemia was identified in 5 of 44 patients of the second group with thyroid carcinoma, as well as in 1 patient of the third group with the same pathology (p=0.246). Conclusion. Incidence of hypocalcemia was more frequent after surgery for hyperthyroidism, especially after total thyroidectomy; in 40% of cases, transient hypocalcemia was identified in patients with autotransplantation of the parathyroid gland after an accidental parathyroidectomy.

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 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.

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