Top

Langenbeck's Archives of Surgery

Published in:

01-11-2017 | Controlled Clinical Trials

Early prediction of hypocalcemia following thyroid surgery. A prospective randomized clinical trial

Authors: Alessandra Saba, Mauro Podda, Antonio Messina Campanella, Adolfo Pisanu

Published in: Langenbeck's Archives of Surgery | Issue 7/2017

Abstract

Purpose

The aim of this randomized-controlled trial was to validate the results of a previous prospective single-cohort observational study conducted in the same surgical unit regarding the use of concomitant intact parathyroid hormone (iPTH) and serum calcium measurement in predicting hypocalcemia after total thyroidectomy.

Methods

From January 2014 to January 2015, 150 patients underwent total thyroidectomy in our department and were randomized into two groups. The experimental group was submitted to iPTH assay 6 h after surgery while the control group was submitted to a daily assay of serum calcium and phosphorus. Sensitivity and specificity of different serum measurements have been calculated using the receiver-operator characteristics (ROC) curve.

Results

The prevalence of hypocalcemia was 14.25% in both groups. The assay of iPTH 6 h after surgery combined with the serum calcium assay 24 h after surgery yielded the highest diagnostic accuracy in predicting hypocalcemia using ROC curves, with 100% sensitivity and 100% specificity.

Conclusions

According to our previous study, the combined measurement of iPTH 6 h after surgery and of serum calcium 24 h after surgery are highly predictive of early postoperative hypocalcemia. These results are important in selecting the patients eligible for early discharge and those who need calcium and vitamin D supplementation.

Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, Pelizzo MR, Pezzullo L (2004) Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 28:271–276CrossRefPubMed

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

Grodski S, Campbell P, Cook MJ, Delbridge L, Farrell S, Gough I, Jalaludi B, Magarey C, Palazzo F, Serpell J, Sidhu S, Soon P, Sywak M, Yeh M (2007) 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 77:199–202CrossRef

Jumaily JS, Noordzij JP, Dukas AG, Lee SL, Bernet VJ, Payne RJ, McLeod IK, Hier MP, Black MJ, Kerr PD, Raffaelli M, Bellantone CP, Lombardi CP, Dietrich MS (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. 32:427–434PubMed

Lombardi CP, Raffaelli M, Princi P, Santini S, Boscherini M, De Crea C, Traini E, D’Amore AM, Carrozza C, Zuppi C, Bellantone R (2004) Early prediction of post thyroidectomy hypocalcemia by one single iPTH measurement. Surgery 136:1236–1241CrossRefPubMed

Pisanu A, Saba A, Coghe F, Uccheddu A (2013) Early prediction of hypocalcaemia following total thyroidectomy using combined intact parathyroid hormone and serum calcium measurement. Langenbeck's Arch Surg 2013(398):423–430CrossRef

Suresh KP (2011) An overview of randomization techniques: an unbiased assessment of outcome in clinical research. J Hum Reprod Sci 4:8–11CrossRefPubMedPubMedCentral

Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, Racadot A, Proye C (1998) Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 22:718–724CrossRefPubMed

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

10.

Adams J, Andersen P, Everts E, Cohen J (1998) Early postoperative calcium levels as predictors of hypocalcemia. Laryngoscope 108:1829–1831CrossRefPubMed

11.

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. 132:584–586CrossRefPubMed

12.

Landry CS, Grubbs EG, Hernandez M, Hu MI, Hansen MO, Lee JE, Perrier ND (2012) PredicF criteria for selective, rather than routine, calcium supplementation following thyroidectomy. Arch Surg 147:338–344CrossRefPubMed

13.

Wang TS, Cheung K, Roman SA, Sosa JA (2011) To supplement or not to supplement: a cost utility analysis of calcium and Vit D repletion in patients after thyroidectomy. Ann Surg Oncol 18:1068–1080CrossRefPubMed

14.

Schlottmann F, Arbulù AL, Sadava EE, Mendez P, Pereyra L, Fernandez Vila JM, Mezzadri NA (2015) Algorithm for early discharge after total thyroidectomy using PTH to predict hypocalcemia: prospective study. Langenbecks Arch Surg 400(7):831–837CrossRefPubMed

15.

Khafif A, Pivoarov A, Medina JE, Avergel A, Gil Z, Fliss DM (2006) Parathyroid hormone: a sensitive predictor of hypocalcemia following total thyroidectomy. Otolaryngol Head Neck Surg 134(6):907–910CrossRefPubMed

16.

White MG, James BC, Nocon C, Nagar S, Kaplan EL, Angelos P, Grogan RH (2016) One-hour PTH after thyroidectomy predicts symptomatic hypocalcemia. J Surg Res 201(2):473–479

17.

AlQahtani A, Parsyan A, Payne R, Tabah R (2014) Parathyroid hormone levels 1 hour after thyroidectomy: n early predictor of postoperative hypocalcaemia. Can J Surg 57(4):237–240

18.

Grodski F (2007) Early postoperative PTH levels as a predictor of hypocalcemia and facilitating safe early discharge after total thyroidectomy. Asian Journal of surgery 30(3):178–182CrossRefPubMed

19.

Sywak MS, Palazzo FF, Yeh M, Wilkinson M, Snook K, Sidhu SB, Delbridge LW (2007) Parathyroid hormone assay predicts hypocalcemia after total thyroidectomy. ANZ J Surg 77(8):667–670CrossRefPubMed

20.

Kim P, Son Y, Kim B, Kim Y, Woo H (2013) Effectiveness of an iPTH measurement in predicting post thyroidectomy hypocalcemia: prospective controlled study. Yonsei Med J 54(3):637–642CrossRefPubMedPubMedCentral

21.

Vescan A, Witterick I, Freeman J (2005) Parathyroid hormone as a predictor of hypocalcemia after thyroidectomy. Laryngoscope 115(12):2105–2108

22.

Chow TL, Choi CY, Chiu AN (2014) Postoperative PTH monitoring of hypocalcemia expedites discharge after thyroidectomy. Am J Otolaryngol 35(6):736–740CrossRefPubMed

23.

Lombardi CP, Raffaelli M, Princi P, Dobrinja C, Carrozza C, Di Stasio E, D'Amore A, Zuppi C, Bellantone R (2006) Parathyroid hormone levels 4 hours after surgery do not accurately predict post-thyroidectomy hypocalcemia. Surgery 140:1016–1025CrossRefPubMed

24.

Payne RJ, Tewfik MA, Hier MP, Tamilia M, Mac Namara E, Young J, Black MJ (2005) Benefits resulting from 1 and 6 hour parathyroid hormone and calcium levels after thyroidectomy. Otolaryngol Head Neck Surg 133:386–390CrossRefPubMed

25.

Payne RJ, Hier MP, Coté V, Tamilia M, Mac Namara E, Black MJ (2005) Postoperative parathyroid hormone levels in conjunction with corrected calcium values as a predictor of post-thyroidectomy hypocalcemia: review of outcomes 1 year after the implementation of a new protocol. J Otolaryngol 34:323–327CrossRefPubMed

26.

Raffaelli M, De Crea C, Carrozza C, D’Amato G, Zuppi C, Bellantone R, Lombardi CP (2012) Combining early postoperative parathyroid hormone and serum calcium levels allows for an efficacious selective post-thyroidectomy supplementation treatment. World J Surg 36(6):1307–1313CrossRefPubMed

Title: Early prediction of hypocalcemia following thyroid surgery. A prospective randomized clinical trial
Authors: Alessandra Saba
Mauro Podda
Antonio Messina Campanella
Adolfo Pisanu
Publication date: 01-11-2017
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 7/2017
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-017-1586-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Early prediction of hypocalcemia following thyroid surgery. A prospective randomized clinical trial

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2017

Polypropelene-mesh properties and type of anchoring do not influence strength of parietal ingrowth

Journal impact factor and methodological quality of surgical randomized controlled trials: an empirical study

Persistent perineal sinus after abdominoperineal resection

Localization of parathyroid adenomas using 11C-methionine pet after prior inconclusive imaging

Systemic inflammatory response after hernia repair: a systematic review

Underestimated risk of cancer in solitary thyroid nodules ≥3 cm reported as benign