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Langenbeck's Archives of Surgery
Published in: Langenbeck's Archives of Surgery 7/2015

01-10-2015 | Original Article

Algorithm for early discharge after total thyroidectomy using PTH to predict hypocalcemia: prospective study

Authors: F. Schlottmann, A. L. Campos Arbulú, E. E. Sadava, P. Mendez, L. Pereyra, J. M. Fernández Vila, N. A. Mezzadri

Published in: Langenbeck's Archives of Surgery | Issue 7/2015

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Abstract

Purpose

Hypocalcemia is the most common complication after total thyroidectomy. The aim of this study was to determine whether postoperative parathyroid hormone (PTH) levels predict hypocalcemia in order to design an algorithm for early discharge.

Methods

We present a prospective study including patients who underwent total thyroidectomy. Hypocalcemia was defined as serum ionized calcium < 1.09 mmol/L or clinical evidence of hypocalcemia. PTH measurement was performed preoperatively and at 1, 3, and 6 h postoperatively. The percent decline of preoperative values was calculated for each time point.

Results

One hundred and six patients were included. Thirty-six (33.9 %) patients presented hypocalcemia. A 50 % decline in PTH levels at 3 h postoperatively showed the highest sensitivity and specificity to predict hypocalcemia (91 and 73 %, respectively). No patients with a decrease <35 % developed hypocalcemia (100 % sensitivity), and all patients with a decrease >80 % had hypocalcemia (100 % specificity).

Conclusions

PTH determination at 3 h postoperatively is a reliable predictor of hypocalcemia. According to the proposed algorithm, patients with less than 80 % drop in PTH levels can be safely discharged the day of the surgery.
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Metadata
Title
Algorithm for early discharge after total thyroidectomy using PTH to predict hypocalcemia: prospective study
Authors
F. Schlottmann
A. L. Campos Arbulú
E. E. Sadava
P. Mendez
L. Pereyra
J. M. Fernández Vila
N. A. Mezzadri
Publication date
01-10-2015
Publisher
Springer Berlin Heidelberg
Published in
Langenbeck's Archives of Surgery / Issue 7/2015
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-015-1341-8

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