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

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.

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Management of Completion and Total Thyroidectomy Patients Based on 1-Hour Postoperative Parathyroid Hormone

The American Surgeon ◽

10.1177/000313481608201004 ◽

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.

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Predicting Postthyroidectomy Hypocalcemia: Improving Predictive Ability of Parathyroid Hormone Level

The American Surgeon ◽

10.1177/000313482008600231 ◽

2020 ◽

Vol 86 (2) ◽

pp. 121-126 ◽

Cited By ~ 1

Author(s):

Veljko Strajina ◽

Benzon M. Dy ◽

Travis J. Mckenzie ◽

Geoffrey B. Thompson ◽

Melanie L. Lyden

Keyword(s):

Parathyroid Hormone ◽

Negative Predictive Value ◽

Predictive Value ◽

Calcium Level ◽

Predictive Ability ◽

Postoperative Hypocalcemia ◽

Total Blood ◽

Blood Calcium ◽

Large Patient ◽

Pth Level

We performed a retrospective study of our large patient cohort aiming to examine the ability to predict postthyroidectomy hypocalcemia. A retrospective review of patients who underwent total or near-total thyroidectomy at our institution between 2008 and 2018 was performed. Postoperative hypocalcemia was defined as Ca level <8.0 mg/dL (reference range: 8.9–10.1 mg/dL) within 30 days of operation. Logistic regression was used to develop models for prediction of the occurrence of postoperative hypocalcemia. Inclusion criteria were met by 1463 patients. Hypocalcemia was documented in 223 patients (15%). Models based on parathyroid hormone (PTH) levels alone had an associated receiver operator characteristic with an areas under the curve (AUC) of 0.79. There was an inverse relationship between time of measurement and PTH levels within the first two hours after thyroidectomy ( P < 0.01). When measured two to six hours after closure, the predictive ability of PTH compared favorably (AUC = 0.82) with either earlier (within the first two hours after closure, AUC = 0.79) or later measurement (6–24 hours after closure, AUC = 0.77). When measured between two and six hours postoperatively, PTH < 19 pg/mL had a sensitivity of 90 per cent and negative predictive value of 96 per cent for postoperative hypocalcemia. The model that included the PTH level, concurrently measured total blood calcium level, and time of measurement had an improved predictive ability with an AUC of 0.87. PTH level of 19 pg/mL measured two to six hours after thyroidectomy had a sensitivity of 90 per cent and a negative predictive value of 96 per cent in our cohort. The model including postoperative PTH level, calcium level, and time of measurement may further improve the ability to predict postthyroidectomy hypocalcemia.

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

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v38i3.14331 ◽

2013 ◽

Vol 38 (3) ◽

pp. 84-89 ◽

Cited By ~ 2

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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Parathormone decline levels are better markers of symptomatic hypocalcemia following total thyroidectomy than parathormone alone

Biomarkers in Medicine ◽

10.2217/bmm-2020-0218 ◽

2020 ◽

Vol 14 (12) ◽

pp. 1121-1126

Author(s):

Sendhil Rajan ◽

Bharadhwaj Ravindhran ◽

Belinda George ◽

Ganapathi Bantwal ◽

Vageesh Ayyar ◽

...

Keyword(s):

Total Thyroidectomy ◽

Predictive Value ◽

Early Discharge ◽

Postoperative Hypocalcemia ◽

Symptomatic Hypocalcemia ◽

The Absolute

Background: We aimed to assess the predictive value of the absolute and relative intact parathormone (iPTH) decline levels as reliable markers of postoperative hypocalcemia. Materials & methods: iPTH levels were measured 4 h after surgery and the following morning after surgery (postoperative day 1). iPTH, absolute iPTH decline (ΔPTH) and relative iPTH decline (ΔPTH%) were calculated and correlated with symptomatic hypocalcemia. Results: Of the 95 patients, 20% of patients (n = 19) developed symptomatic hypocalcemia. The ΔPTH (U = 206; p < 0.001) and ΔPTH% (U = 127; p < 0.001) were significantly higher in patients with symptomatic hypocalcemia. A ΔPTH% of 20% (sensitivity of 84%; specificity of 91%); and an absolute iPTH decline of 3.75 pg/ml (sensitivity of 74%; specificity of 87%) were highly predictive of symptomatic hypocalcemia. Conclusion: Postoperative ΔPTH and ΔPTH% have the potential to be predictors of symptomatic hypocalcemia following thyroidectomy and could facilitate a safe early discharge.

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

International Surgery Journal ◽

10.18203/2349-2902.isj20174106 ◽

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.

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Parathyroid Hormone Levels Predict Posttotal Thyroidectomy Hypoparathyroidism

The American Surgeon ◽

10.1177/000313481408000835 ◽

2014 ◽

Vol 80 (8) ◽

pp. 817-820 ◽

Cited By ~ 2

Author(s):

Amy E. Rivere ◽

Ashton J. Brooks ◽

Genevieve A. Hayek ◽

Heng Wang ◽

Ralph L. Corsetti ◽

...

Keyword(s):

Parathyroid Hormone ◽

Hospital Stay ◽

Total Thyroidectomy ◽

Recent Experience ◽

Active Vitamin ◽

Parathyroid Autotransplantation ◽

Shorten Hospital Stay ◽

Postoperative Serum ◽

Pth Level

We hypothesized that parathyroid hormone (PTH) determination would be the most effective strategy to identify posttotal thyroidectomy hypoparathyroidism (PTTHP) compared with other clinical and laboratory parameters. We retrospectively reviewed our recent experience with total thyroidectomy. We recorded demographics, malignancy, thyroid weight, parathyroid autotransplantation, hospital stay, use of postoperative calcium and hormonally active vitamin D3 (calcitriol), and postoperative serum calcium and PTH levels. Patients were divided into two groups depending on whether supplemental calcitriol was required to maintain eucalcemia and therefore reflecting the diagnosis of PTTHP. From October 2010 to June 2013, a total of 202 total thyroidectomies were performed. Twenty-four patients (12%) developed PTTHP and required calcitriol replacement. Logistic regression analysis revealed that only postoperative calcium levels ( P = 0.02) and PTH levels ( P < 0.0001) statistically significantly predicted PTTHP. Twenty-two of 29 patients with PTH 13 pg/mL or less had PTTHP. Only two of 173 patients with a PTH level greater than 13 pg/mL were diagnosed with PTTHP. We recommend using PTH levels after total thyroidectomy to determine which patients will have hypoparathyroidism requiring calcitriol therapy. An early determination of PTTHP allows for prompt management that can shorten hospital stay and improve outcomes.

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Hypocalcaemia after total thyroidectomy: Could intact parathyroid hormone be a predictive factor for transient postoperative hypocalcemia?

Surgery ◽

10.1016/j.surg.2014.09.004 ◽

2015 ◽

Vol 157 (2) ◽

pp. 344-348 ◽

Cited By ~ 22

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

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Senile parathyroid dysfunction: Characteristics of its diagnosis and treatment

Journal of Translational Internal Medicine ◽

10.1515/jtim-2013-0009 ◽

2013 ◽

Vol 1 (1) ◽

pp. 32-35

Author(s):

Shuang-Tong Yan ◽

Hui Tian

Keyword(s):

Peritoneal Dialysis ◽

Parathyroid Hormone ◽

Surgical Treatment ◽

Early Identification ◽

The Elderly ◽

Blood Calcium ◽

The Common ◽

Parathyroid Dysfunction ◽

End Stage ◽

Pth Level

AbstractSenile parathyroid dysfunction is mainly seen in primary or secondary hyperparathyroidism (pHPT or sHPT). pHPT in the elderly usually occurs in women, with fatigue and osteoporosis as the common symptoms. Screening of blood calcium and further evaluation of parathyroid hormone (PTH) for subjects with serum calcium >2.6 mmol/L can be helpful for early identification of patients. For pHPT patients with no contraindications to surgery and whose lesions can be well-localized, surgical treatment can be more beneficial. sHPT is mainly found in patients with end-stage chronic renal dysfunction necessitating hemodialysis or peritoneal dialysis. For these patients, monitoring of PTH level, early supplement of calcium preparations and use of large-dose calcitriol will facilitate maintaining levels of blood calcium and PTH.

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

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302012000300003 ◽

2012 ◽

Vol 56 (3) ◽

pp. 168-172 ◽

Cited By ~ 18

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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