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Langenbeck's Archives of Surgery

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Open Access 05-03-2022 | Hypoparathyroidism | Original Article

Predictive value of postoperative day 1 parathyroid hormone levels for early and late hypocalcaemia after thyroidectomy

Authors: Fiona Riordan, Catherine Brophy, Matthew S. Murphy, Patrick Sheahan

Published in: Langenbeck's Archives of Surgery | Issue 4/2022

Abstract

Purpose

Early parathyroid hormone (PTH) levels after total thyroidectomy can predict patients at low risk of hypocalcaemia who can be discharged early without calcium supplementation. For centres without facility to perform early PTH levels, PTH levels sent on the first postoperative day (POD1) may be an alternative. However, there is less data regarding optimal cut-off PTH levels for POD1 discharge.

Methods

Retrospective review of prospective database of thyroid operations between September 2009 and February 2020 at tertiary referral centre. Main outcome measure was symptomatic hypocalcaemia.

Results

Five hundred seventy patients undergoing total (521) or completion thyroidectomy with POD1 PTH levels available were included. Among patients with POD1 PTH levels ≥ 20 pg/ml and POD1 calcium ≥ 2.0 mmol/l, the incidence of symptomatic hypocalcaemia was 1% (3/300), and need for intravenous calcium 0.3% (1/300). For POD1 PTH levels 15–19 pg/ml and POD1 calcium ≥ 2.0 mmol/l, the incidence of symptomatic hypocalcaemia and need for intravenous calcium was 5.4% (3/55). For PTH levels 10–14 pg/ml and calcium ≥ 2.0 mmol/l, the incidence of symptomatic hypocalcaemia and need for intravenous calcium was 11.7% (7/60). The risk of permanent hypoparathyroidism was < 1% for POD1 PTH levels ≥ 15 pg/ml; 5.4% for levels 10–14 pg/ml; and 19.8% for levels < 10 pg/ml.

Conclusions

POD1 PTH levels ≥ 15 pg/ml along with calcium ≥ 2.0 mmol/l are associated with low risk of symptomatic hypocalcaemia, and represent a safe criterion for discharge of most patients without calcium supplementation. For certain patient groups, a higher threshold of 20 pg/ml could be considered.

Brophy C, Woods R, Murphy MS, Sheahan P (2019) Perioperative magnesium levels in total thyroidectomy and relationship to hypocalcemia. Head Neck 41(6):1713–1718. https://doi.org/10.1002/hed.25644CrossRefPubMed

Del Rio P, Arcuri MF, Ferreri G, Sommaruga L, Sianesi M (2005) The utility of serum PTH assessment 24 hours after total thyroidectomy. Otolaryngol Head Neck Surg 132(4):584–586. https://doi.org/10.1016/j.otohns.2005.01.009CrossRefPubMed

Lombardi CP, Raffaelli M, Princi P, Dobrinja C, Carrozza C, Di Stasio E, et al. Parathyroid hormone levels 4 hours after surgery do not accurately predict post-thyroidectomy hypocalcemia. Surgery. 2006;140(6):1016–23; discussion 23–5. S0039–6060(06)00538–1 [pii]. https://doi.org/10.1016/j.surg.2006.08.009

Reddy AC, Chand G, Sabaretnam M, Mishra A, Agarwal G, Agarwal A et al (2016) Prospective evaluation of intra-operative quick parathyroid hormone assay as an early predictor of post thyroidectomy hypocalcaemia. Int J Surg 34:103–108. https://doi.org/10.1016/j.ijsu.2016.08.010CrossRefPubMed

Vescan A, Witterick I, Freeman J (2005) Parathyroid hormone as a predictor of hypocalcemia after thyroidectomy. Laryngoscope 115(12):2105–2108. https://doi.org/10.1097/01.MLG.0000181504.69230.87CrossRefPubMed

Wilson RB, Erskine C, Crowe PJ (2000) Hypomagnesemia and hypocalcemia after thyroidectomy: prospective study. World J Surg 24(6):722–726CrossRef

Jumaily JS, Noordzij JP, Dukas AG, Lee SL, Bernet VJ, Payne RJ et al (2010) Prediction of hypocalcemia after using 1- to 6-hour postoperative parathyroid hormone and calcium levels: an analysis of pooled individual patient data from 3 observational studies. Head Neck 32(4):427–434. https://doi.org/10.1002/hed.21199CrossRefPubMed

Lang BH, Yih PC, Ng KK (2012) A prospective evaluation of quick intraoperative parathyroid hormone assay at the time of skin closure in predicting clinically relevant hypocalcemia after thyroidectomy. World J Surg 36(6):1300–1306. https://doi.org/10.1007/s00268-012-1561-9CrossRefPubMedPubMedCentral

Saba A, Podda M, Messina Campanella A, Pisanu A. Early prediction of hypocalcemia following thyroid surgery. A prospective randomized clinical trial. Langenbecks Arch Surg. 2017;402(7):1119–25. https://doi.org/10.1007/s00423-017-1586-5

10.

Puzziello A, Gervasi R, Orlando G, Innaro N, Vitale M, Sacco R (2015) Hypocalcaemia after total thyroidectomy: could intact parathyroid hormone be a predictive factor for transient postoperative hypocalcemia? Surgery 157(2):344–348. https://doi.org/10.1016/j.surg.2014.09.004CrossRefPubMed

11.

Group AG. Australian Endocrine Surgeons Guidelines AES06/01. Postoperative parathyroid hormone measurement and early discharge after total thyroidectomy: analysis of Australian data and management recommendations. ANZ J Surg. 2007;77(4):199–202. https://doi.org/10.1111/j.1445-2197.2007.04018.x

12.

Sywak MS, Palazzo FF, Yeh M, Wilkinson M, Snook K, Sidhu SB et al (2007) Parathyroid hormone assay predicts hypocalcaemia after total thyroidectomy. ANZ J Surg 77(8):667–670. https://doi.org/10.1111/j.1445-2197.2007.04183.xCrossRefPubMed

13.

Cayo AK, Yen TW, Misustin SM, Wall K, Wilson SD, Evans DB et al (2012) Predicting the need for calcium and calcitriol supplementation after total thyroidectomy: results of a prospective, randomized study. Surgery 152(6):1059–1067. https://doi.org/10.1016/j.surg.2012.08.030CrossRefPubMed

14.

Karatzanis AD, Ierodiakonou DP, Fountakis ES, Velegrakis SG, Doulaptsi MV, Prokopakis EP et al (2018) Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy. Head Neck 40(5):1040–1045. https://doi.org/10.1002/hed.25081CrossRefPubMed

15.

Landry CS, Grubbs EG, Hernandez M, Hu MI, Hansen MO, Lee JE et al (2012) Predictable criteria for selective, rather than routine, calcium supplementation following thyroidectomy. Arch Surg 147(4):338–344. https://doi.org/10.1001/archsurg.2011.1406CrossRefPubMed

16.

Selberherr A, Scheuba C, Riss P, Niederle B (2015) Postoperative hypoparathyroidism after thyroidectomy: efficient and cost-effective diagnosis and treatment. Surgery 157(2):349–353. https://doi.org/10.1016/j.surg.2014.09.007CrossRefPubMed

17.

Toniato A, Boschin IM, Piotto A, Pelizzo M, Sartori P (2008) Thyroidectomy and parathyroid hormone: tracing hypocalcemia-prone patients. Am J Surg 196(2):285–288. https://doi.org/10.1016/j.amjsurg.2007.06.036CrossRefPubMed

18.

Filho EBY, Machry RV, Mesquita R, Scheffel RS, Maia AL (2018) The timing of parathyroid hormone measurement defines the cut-off values to accurately predict postoperative hypocalcemia: a prospective study. Endocrine 61(2):224–231. https://doi.org/10.1007/s12020-018-1601-9CrossRefPubMed

19.

Lee YM, Cho JY, Sung TY, Kim TY, Chung KW, Hong SJ et al (2015) Clinicopathological risk factors and biochemical predictors of safe discharge after total thyroidectomy and central compartment node dissection for thyroid cancer: a prospective study. Int J Endocrinol 2015:214525. https://doi.org/10.1155/2015/214525CrossRefPubMedPubMedCentral

20.

Košec A, Hergešić F, Matovinović F, Rašić I, Vagić D, Bedeković V (2020) Identifying early postoperative serum parathyroid hormone levels as predictors of hypocalcaemia after total thyroidectomy: a prospective non-randomized study. Am J Otolaryngol 41(3):102416. https://doi.org/10.1016/j.amjoto.2020.102416CrossRefPubMed

21.

Sahli Z, Najafian A, Kahan S, Schneider EB, Zeiger MA, Mathur A (2018) One-hour postoperative parathyroid hormone levels do not reliably predict hypocalcemia after thyroidectomy. World J Surg 42(7):2128–2133. https://doi.org/10.1007/s00268-017-4444-2CrossRefPubMedPubMedCentral

22.

Payne RJ, Hier MP, Tamilia M, Mac Namara E, Young J, Black MJ (2005) Same-day discharge after total thyroidectomy: the value of 6-hour serum parathyroid hormone and calcium levels. Head Neck 27(1):1–7. https://doi.org/10.1002/hed.20103CrossRefPubMed

23.

Pisanu A, Saba A, Coghe F, Uccheddu A (2013) Early prediction of hypocalcemia following total thyroidectomy using combined intact parathyroid hormone and serum calcium measurement. Langenbecks Arch Surg 398(3):423–430. https://doi.org/10.1007/s00423-012-1017-6CrossRefPubMed

Title: Predictive value of postoperative day 1 parathyroid hormone levels for early and late hypocalcaemia after thyroidectomy
Authors: Fiona Riordan
Catherine Brophy
Matthew S. Murphy
Patrick Sheahan
Publication date: 05-03-2022
Publisher: Springer Berlin Heidelberg
Keywords: Hypoparathyroidism
Thyroidectomy
Thyroidectomy
Published in: Langenbeck's Archives of Surgery / Issue 4/2022
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-022-02480-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Predictive value of postoperative day 1 parathyroid hormone levels for early and late hypocalcaemia after thyroidectomy

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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