Combining Early Postoperative Parathyroid Hormone and Serum Calcium Levels Allows for an Efficacious Selective Post‐thyroidectomy Supplementation Treatment
- 16 March 2012
- journal article
- clinical trial
- Published by Wiley in World Journal of Surgery
- Vol. 36 (6), 1307-1313
- https://doi.org/10.1007/s00268-012-1556-6
Abstract
Optimal treatment protocol to prevent symptomatic hypocalcemia following total thyroidectomy is still matter of debate. We prospectively evaluated the efficacy of a selective supplementation protocol based on both early postoperative intact parathyroid hormone (iPTH) and serum calcium levels. Two hundred thirty consecutive patients were divided in three different groups of treatment according to iPTH levels 4 h after total thyroidectomy (4 h-iPTH) and serum calcium levels in the first postoperative day (1PO-Ca): group A (4 h-iPTH > 10 pg/ml, 1PO-Ca ≥ 8.5 mg/dl), no treatment; group B (4 h-iPTH > 10 pg/ml, 1PO-Ca < 8.5 mg/dl), oral calcium (OC) 3 g per day; and group C (4 h-iPTH ≤ 10 pg/ml), OC 3 g + calcitriol (VD) 1 μg per day. Development of biochemical and/or symptomatic hypocalcemia was evaluated. Fifty-nine patients (25.6%) had subnormal 4 h-iPTH levels (≤10 pg/ml) (group C). Among patients with normal 4 h-iPTH levels, 25 (10.9%) had subnormal 1PO-Ca (<8.5 mg/dl) (group B). The remaining 146 patients (63.5%) had normal 4 h-iPTH and 1PO-Ca levels (group A). One patient in group A, 2 in group B, and 18 in group C developed biochemical hypocalcemia. Only one patient in group C experienced major symptoms. Treatment was discontinued within 1 month in all the patients in group B. At a mean follow-up of 303 days, five patients in group C were still under supplementation treatment. The proposed supplementation protocol seems efficacious in preventing symptomatic hypocalcemia. It could allow a safe and early discharge of most patients, thus avoiding the constraints and the costs of routine supplementation.Keywords
This publication has 53 references indexed in Scilit:
- An Algorithm Informed by the Parathyroid Hormone Level Reduces Hypocalcemic Complications of ThyroidectomyWorld Journal of Surgery, 2010
- Parathyroid hormone levels 4 hours after surgery do not accurately predict post-thyroidectomy hypocalcemiaSurgery, 2006
- Parathyroid Hormone as a Predictor of Hypocalcemia after ThyroidectomyThe Laryngoscope, 2005
- Serum intact parathyroid hormone as a predictor of hypocalcaemia after total thyroidectomyAnz Journal of Surgery, 2005
- Benefits Resulting from 1- and 6-hour Parathyroid Hormone and Calcium Levels After ThyroidectomyOtolaryngology -- Head and Neck Surgery, 2005
- Perioperative Parathyroid Hormone Assay for Diagnosis and Management of Postthyroidectomy HypocalcemiaThe Laryngoscope, 2005
- Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurementSurgery, 2004
- Parathyroid Hormone: An Early Predictor of Postthyroidectomy HypocalcemiaThe Laryngoscope, 2003
- Applicability of Intraoperative Parathyroid Hormone Assay During ThyroidectomyAnnals of Surgery, 2002
- Outpatient thyroid and parathyroid surgery: A prospective study of feasibility, safety, and costsSurgery, 1995