PTH after Thyroidectomy as a Predictor of Post-Operative Hypocalcemia

Post-thyroidectomy hypocalcemia is a frequent complication with significant morbidity, and has been shown to increase hospital stay and readmission rates. The evaluation of serum parathyroid hormone (PTH) levels after thyroidectomy represents a reliable method to predict post-thyroidectomy hypocalcemia, but it remains infrequently used. This retrospective study investigates serum PTH values 3 h after thyroidectomy as a predictor of hypocalcemia. In this study, we enrolled 141 patients aged between 27 and 71 years eligible for total thyroidectomy who presented with multinodular goiter, suspicious nodule on cytological examination, Graves’ disease, or toxic multinodular goiter. Three hours after total thyroidectomy, 53 patients (37.6%) showed a reduction in serum PTH. Of these patients 75.5% developed hypocalcemia by 24 h after surgery and 100% were hypocalcemic after 48 h (p < 0.001). There was no significant difference attributable to the different thyroid diseases, nor to the age of the patients. PTH at 3 h after total thyroidectomy accurately predicts post-operative hypocalcemia. The early detection of patients at risk of developing post-operative hypocalcemia allows for prompt supplementation of calcium and Vitamin D in order to prevent symptoms and allows for a safe and timely discharge.

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Major post-operative complications of thyroid surgery: Preventable or not?

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v34i3.1973 ◽

2009 ◽

Vol 34 (3) ◽

pp. 99-103 ◽

Cited By ~ 1

Author(s):

M.A. Majid ◽

Md. Ibrahim Siddique

Keyword(s):

Total Thyroidectomy ◽

Vocal Cord ◽

Thyroid Surgery ◽

Multinodular Goiter ◽

Vocal Cord Palsy ◽

Subtotal Thyroidectomy ◽

Permanent Hypoparathyroidism ◽

Respiratory Obstruction ◽

Operative Complications ◽

Toxic Multinodular Goiter

Factors responsible for major complications following thyroid surgery in 598 patients were studied. Patients with non toxic multinodular goiter involving both lobes of thyroid constituted the maximum bulk subjected to thyroidectomy. The most frequent procedure was bilateral subtotal thyroidectomy. Reactionary hemorrhage occurred in 6 patients, all following bilateral procedures and among them 5 patients developed tension hematoma with respiratory obstruction despite the presence of a drain. Temporary vocal cord palsy was observed in 7 patients whereas one patient subjected to total thyroidectomy with neck dissection for papillary carcinoma of thyroid developed permanent right vocal cord palsy. Temporary parathyroid insufficiency was seen in 51 patients and one patient developed permanent hypoparathyroidism. Incidence of parathyroid insufficiency was higher in bilateral procedures as compared to unilateral ones. There was no operation related death in this series, but complications like hemorrhage, vocal cord palsy and parathyroid insufficiency following thyroid surgery are still a deep concern. Keywords: Complication; Post-operative; Thyroid surgeryOnline: 29-1-2009DOI: 10.3329/bmrcb.v34i3.1973Â Â Â Â Â Bangladesh Med Res Counc Bull 2008; 34: 99-103.Â

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Malignancy in Clinically Non-toxic Multinodular Goiter

Ibrahim Cardiac Medical Journal ◽

10.3329/icmj.v10i1-2.54012 ◽

2021 ◽

Vol 10 (1-2) ◽

pp. 84-88

Author(s):

Mohd Shahjahan Ali ◽

Md Habibullah Sarkar ◽

Syeda Momena Hossain

Keyword(s):

Total Thyroidectomy ◽

Multinodular Goiter ◽

Histopathological Examination ◽

Follicular Adenoma ◽

Cervical Lymphadenopathy ◽

Follicular Carcinoma ◽

Chronic Thyroiditis ◽

College Hospital ◽

Toxic Multinodular Goiter ◽

Thyroid Swelling

Objective: Goiter is a common form of thyroid swelling among population living in areas of iodine deficiency. Of the goiters, non-toxic multinodular goiter (MNG) is the most common and benign form of thyroid disease. However, studies have shown that long-standing MNGs may harbour malignancy. The present study was, therefore, undertaken to ascertain the prevalence of malignancy in clinically diagnosed non-toxic MNGs. Methods: This cross-sectional study was conducted in the Department of Surgery (all four-units) and ENT Department, Rajshahi Medical College Hospital, Rajshahi from July 2007 to June 2008 on 100 patients of clinically non-toxic MNG who underwent thyroid surgery. Biopsy materials were taken from the excised nodules and were sent for histopathological examination to see what proportion of them harboured malignancy. Result: The findings of the study showed that 40% of patients were 30-40 years old with mean age of the patients being 35.5 ± 10.1 (range: 14-75) years. Majority (87%) of the patients was female. Half of the patients with non-toxic MNGs had a history of thyroid swelling for 1-5 years and the rest half for > 5 years with median duration of illness being 5.5 years (range: 1-30 years). Of the 100 patients 4% had stridor and 6% dyspnoea; dysphagia and cervical lymphadenopathy each was 6%. Nearly 60% of the patients had goiter of size 15 sq-cm or below. Sub-total thyroidectomy was the most common operation performed (33%) followed by right hemi-thyroidectomy (24%), near total thyroidectomy (20%), left hemi-thyroidectomy (18%) and total thyroidectomy (5%). Histopathological examination of resected specimens revealed that 15% of the MNGs had malignancy with papillary to follicular carcinoma ratio being 4:1. Histopathological typing showed that 79% was simple MNGs, 4% follicular adenoma, 12% papillary carcinoma, 3% follicular carcinoma and 2% chronic thyroiditis. Neither age nor sex was found to be associated with presence of malignancies in MNGs (p = 0.865 and p = 0.647 respectively). The goiter-size was also not associated with presence of malignancies (p = 0.691). However, the mean duration of thyroid swelling in patients who had malignancy was much higher (8.5 years) than that in patients who did not haveany malignancy (5.7 years) (p = 0.024). Conclusion: The study concluded that a small proportion of long-standing non-toxic MNGs may turn into malignancy. Therefore, routine operative treatment without confirming that the cases are malignant does not seem to be justified. Ibrahim Card Med J 2020; 10 (1&2): 84-88

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Total thyroidectomy for non-toxic multinodular goiter with versus without the use of harmonic FOCUS dissecting shears – a prospective randomized study

Videosurgery and Other Miniinvasive Techniques ◽

10.5114/wiitm.2011.30675 ◽

2012 ◽

Vol 4 ◽

pp. 268-274 ◽

Cited By ~ 2

Author(s):

Aleksander Konturek ◽

Marcin Barczyński ◽

Małgorzata Stopa ◽

Wojciech Nowak

Keyword(s):

Total Thyroidectomy ◽

Multinodular Goiter ◽

Randomized Study ◽

Prospective Randomized Study ◽

Harmonic Focus ◽

Toxic Multinodular Goiter

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Surgical Management of Toxic Multinodular Goiter

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1060 ◽

2011 ◽

Vol 3 (2) ◽

pp. 69-73

Author(s):

Antoine Digonnet ◽

Esther Willemse ◽

Cécile Dekeyser ◽

Nicolas de Saint Aubain ◽

Moreau Michel ◽

...

Keyword(s):

Total Thyroidectomy ◽

Vocal Cord ◽

Multinodular Goiter ◽

Vocal Cord Palsy ◽

Primary Treatment ◽

Definitive Treatment ◽

Large Goiter ◽

Appropriate Treatment ◽

Tertiary Center ◽

Toxic Multinodular Goiter

ABSTRACT Management of toxic multinodular goiter (TMNG) is still debated. We report our current experience with thyroidectomy for toxic multinodular goiter at a tertiary center. A retrospective database of 141 patients who underwent surgery for TMNG disease from January 1985 to December 2008. During that period, six patients underwent subtotal thyroidectomy and 135 patients underwent near total thyroidectomy. Around 53 patients (38%) underwent surgery for recurrent disease after medical therapy; 88 patients (62%) had surgery as a primary treatment, the indications were large goiter size in 58 (66%), associated cold nodule in 16 (18%), patient preference in 14 (16%). The incidence of cancer was 6.4%. Permanent hypoparathyroidism was observed in two patients. Unilateral transitory vocal cord palsy was observed in 11 patients (8%), no bilateral transitory vocal cord palsy was observed. One unilateral definitive vocal cord palsy was observed and was provoked by a mediastinal compression. Two patients (1.5%) experienced postoperative hemorrhagia requiring surgical revision. Near total thyroidectomy for TMNG provide an immediate and definitive treatment with a low complication rate. Near total thyroidectomy offers an appropriate treatment for coexisting malignancy. Only NTT can alleviate compressive symptoms. This procedure can be safely recommended even as a primary treatment.

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Evaluation of Serum parathyroid hormone level measurement in total thyroidectomy patients

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v23i1.45105 ◽

2020 ◽

Vol 23 (1) ◽

pp. 5-10

Author(s):

Islam MS ◽

Sultana T ◽

Paul D ◽

Huq AHMZ ◽

Ferdoushi S ◽

...

Keyword(s):

Parathyroid Hormone ◽

Total Thyroidectomy ◽

Hormone Level ◽

Clinical Pathology ◽

T Test ◽

Parathyroid Hormone Level ◽

Serum Parathyroid Hormone ◽

Level Measurement ◽

Postoperative Hypoparathyroidism ◽

Serum Pth

Background: Postoperative hypoparathyroidism is a common complication after total thyroidectomy. It is necessary to diagnose hypoparathyroidism immediately after total thyroidectomy for minimizing complications. Objective: The objective of this study was to measure and to evaluate the serum parathyroid hormone level in total thyroidectomy patients. Methods: This prospective observational study was carried out in the Department of Clinical Pathology in collaboration with Department of Surgery & Department of Otolaryngology of BSMMU and Department of Otolaryngology of DMCH, Dhaka, during the period of September 2010 to August 2011. Results: Total 65 patients were studied irrespective of age and sex. Decreased serum PTH was found in 9 cases and normal parathyroid hormone was found in 56 cases. Male was 16.0% and female was 84.0%. Females were predominant. The incidence of hypoparathyroidism was 41.5%. Asymptomatic hypoparathyroidism was found in 8 and symptomatic hypoparathyroidism was found in 1 cases. Decreased serum PTH was developed mostly in malignant thyroid diseases. In relation to preoperative PTH values, intraoperative PTH levels were lower from 5.48% to 90.0%, (mean±SD in percentage is 65.3±16.7, p=.001) which is significant in paired t test. The mean difference of intraoperative (20 minutes after total thyroidectomy), parathyroid hormone levels were statistically significant (p<0.05) between patient with decreased parathyroid hormone and patient with normal parathyroid hormone in unpaired t-test. Conclusion: Serum parathyroid hormone level significantly decreased 20 minutes after total thyroidectomy. If clinical sign symptoms of hypoparathyroidism are not developed in postoperative period, patient is safe and can be discharged from hospital. Bangladesh J Otorhinolaryngol; April 2017; 23(1): 5-10

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Abstract #1008: A Case of Papillary Thyroid Cancer in a Patient with Toxic Multinodular Goiter

Endocrine Practice ◽

10.1016/s1530-891x(20)44130-8 ◽

2017 ◽

Vol 23 ◽

pp. 213-214

Author(s):

Gisell Sanchez ◽

Juan Pablo Galvez

Keyword(s):

Thyroid Cancer ◽

Papillary Thyroid Cancer ◽

Multinodular Goiter ◽

Papillary Thyroid ◽

Toxic Multinodular Goiter

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Rare association of primary hyperparathyroidism and toxic multinodular goiter

Endocrine Abstracts ◽

10.1530/endoabs.56.p1025 ◽

2018 ◽

Author(s):

Hamza Elfekih ◽

Mouna Elleuch ◽

Dorra Ghorbel ◽

Faten Hadjkacem ◽

Mouna Ammar ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Multinodular Goiter ◽

Rare Association ◽

Toxic Multinodular Goiter

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Low serum parathyroid hormone is a risk factor for peritonitis episodes in incident peritoneal dialysis patients: a retrospective study

BMC Nephrology ◽

10.1186/s12882-021-02241-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yuqi Yang ◽

Jingjing Da ◽

Yi Jiang ◽

Jing Yuan ◽

Yan Zha

Keyword(s):

Risk Factor ◽

Peritoneal Dialysis ◽

Parathyroid Hormone ◽

Proportional Hazard ◽

Serum Parathyroid Hormone ◽

Cox Proportional Hazard ◽

Cox Proportional Hazard Regression ◽

Gram Negative Organisms ◽

Serum Pth

Abstract Background Serum parathyroid hormone (PTH) levels have been reported to be associated with infectious mortality in peritoneal dialysis (PD) patients. Peritonitis is the most common and fatal infectious complication, resulting in technique failure, hospital admission and mortality. Whether PTH is associated with peritonitis episodes remains unclear. Methods We examined the association of PTH levels and peritonitis incidence in a 7-year cohort of 270 incident PD patients who were maintained on dialysis between January 2012 and December 2018 using Cox proportional hazard regression analyses. Patients were categorized into three groups by serum PTH levels as follows: low-PTH group, PTH < 150 pg/mL; middle-PTH group, PTH 150-300 pg/mL; high-PTH group, PTH > 300 pg/mL. Results During a median follow-up of 29.5 (interquartile range 16–49) months, the incidence rate of peritonitis was 0.10 episodes per patient-year. Gram-positive organisms were the most common causative microorganisms (36.2%), and higher percentage of Gram-negative organisms was noted in patients with low PTH levels. Low PTH levels were associated with older age, higher eGFR, higher hemoglobin, calcium levels and lower phosphate, alkaline phosphatase levels. After multivariate adjustment, lower PTH levels were identified as an independent risk factor for peritonitis episodes [hazard ratio 1.643, 95% confidence interval 1.014–2.663, P = 0.044]. Conclusions Low PTH levels are independently associated with peritonitis in incident PD patients.

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Comparing Patient Characteristics, Clinical Outcomes, and Biomarkers of Severe Asthma Patients in Taiwan

Biomedicines ◽

10.3390/biomedicines9070764 ◽

2021 ◽

Vol 9 (7) ◽

pp. 764

Author(s):

Shih-Lung Cheng ◽

Kuo-Chin Chiu ◽

Hsin-Kuo Ko ◽

Diahn-Warng Perng ◽

Hao-Chien Wang ◽

...

Keyword(s):

Severe Asthma ◽

Clinical Characteristics ◽

Linear Models ◽

Patient Characteristics ◽

Emergency Department Visits ◽

Receiver Operating Characteristic Curves ◽

Increased Risk ◽

Significant Difference ◽

Asthma Patients ◽

Patients At Risk

Purpose: To understand the association between biomarkers and exacerbations of severe asthma in adult patients in Taiwan. Materials and Methods: Demographic, clinical characteristics and biomarkers were retrospectively collected from the medical charts of severe asthma patients in six hospitals in Taiwan. Exacerbations were defined as those requiring asthma-specific emergency department visits/hospitalizations, or systemic steroids. Enrolled patients were divided into: (1) those with no exacerbations (non-exacerbators) and (2) those with one or more exacerbations (exacerbators). Receiver operating characteristic curves were used to determine the optimal cut-off value for biomarkers. Generalized linear models evaluated the association between exacerbation and biomarkers. Results: 132 patients were enrolled in the study with 80 non-exacerbators and 52 exacerbators. There was no significant difference in demographic and clinical characteristics between the two groups. Exacerbators had significantly higher eosinophils (EOS) counts (367.8 ± 357.18 vs. 210.05 ± 175.24, p = 0.0043) compared to non-exacerbators. The optimal cut-off values were 292 for EOS counts and 19 for the Fractional exhaled Nitric Oxide (FeNO) measure. Patients with an EOS count ≥ 300 (RR = 1.88; 95% CI, 1.26–2.81; p = 0.002) or FeNO measure ≥ 20 (RR = 2.10; 95% CI, 1.05–4.18; p = 0.0356) had a significantly higher risk of exacerbation. Moreover, patients with both an EOS count ≥ 300 and FeNO measure ≥ 20 had a significantly higher risk of exacerbation than those with lower EOS count or lower FeNO measure (RR = 2.16; 95% CI, 1.47–3.18; p = < 0.0001). Conclusions: Higher EOS counts and FeNO measures were associated with increased risk of exacerbation. These biomarkers may help physicians identify patients at risk of exacerbations and personalize treatment for asthma patients.

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