Advertisement

Journal of Endocrinological Investigation

, Volume 30, Issue 8, pp 666–671 | Cite as

The impact of thyroidectomy on parathyroid glands: A biochemical and clinical profile

  • P. Miccoli
  • M. N. MinutoEmail author
  • E. Panicucci
  • F. Cetani
  • J. D’Agostino
  • E. Vignali
  • A. Picone
  • C. Marcocci
  • P. Berti
Original Articles

Abstract

Introduction: An evaluation of PTH levels during thyroid surgery may reflect the functional status of the parathyroids and be useful in identifying patients at risk for hypocalcemia. This study aims to monitor the parathyroid function during total thyroidectomy through intra-operative serial samples for calcium and PTH. Materials and methods: Forty-seven patients undergoing total thyroidectomy for different diseases were selected for the study. Patients underwent serum PTH and calcium sampling at the induction of anesthesia (T0) and after the first (T1) and the second (T2) lobectomy. Serum calcium was also drafted 24 h after the operation. Results: Mean PTH at T0, T1, and T2 was, respectively: 32.1 pg/ml, 19.6 pg/ml, and 11.5 pg/ml. PTH was significantly higher at T0 when compared to T1 (p<0.0001). It was also significantly higher at T1 than at T2 (p<0.0001). At T1 PTH levels were below the normal range in 20/47 cases (42.5%) and at T2 in 31/47 cases (66%). Twenty-four h after surgery, 8 patients (17%) demonstrated a biochemical hypocalcemia. A PTH value at T0 in the upper (>70 pg/ml) or in the lower (<20 pg/ml) limits of the normal range was statistically related to post-operative hypocalcemia (p=0.017). Discussion: The study seems to confirm that serum PTH during thyroidectomy does not represent a sensitive tool in precociously identifying hypocalcemic patients. Nevertheless, before surgery, a PTH concentration at the higher or lower normal limit may help to identify patients “at risk” of developing hypocalcemia.

Key-words

Thyroid surgery thyroidectomy intra-operative parathyroid hormone sampling hypocalcemia 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Irvin GL 3rd, Deriso GT 3rd. A new, practical intraoperative parathyroid hormone assay. Am J Surg 1994, 168: 466–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Vignali E, Picone A, Materazzi G, et al. A quick intraoperative parathyroid hormone assay in the surgical management of patients with primary hyperparathyroidism: a study of 206 consecutive cases. Eur J Endocrinol 2002, 146: 783–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Quiros RM, Pesce CE, Wilhelm SM, Djuricin G, Prinz RA. Intraoperative parathyroid hormone levels in thyroid surgery are predictive of postoperative hypoparathyroidism and need for vitamin D supplementation. Am J Surg 2005, 189: 306–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Richards ML, Bingener-Casey J, Pierce D, Strodel WE, Sirinek KR. Intraoperative parathyroid hormone assay: an accurate predictor of symptomatic hypocalcemia following thyroidectomy. Arch Surg 2003, 138: 632–5; discussion 635-6.PubMedCrossRefGoogle Scholar
  5. 5.
    Lindblom P, Westerdahl J, Bergenfelz A. Low parathyroid hormone levels after thyroid surgery: a feasible predictor of hypocalcemia. Surgery 2002, 131: 515–20.PubMedCrossRefGoogle Scholar
  6. 6.
    Warren FM, Andersen PE, Wax MK, Cohen JI. Perioperative parathyroid hormone levels in thyroid surgery: preliminary report. Laryngoscope 2004, 114: 689–93.PubMedCrossRefGoogle Scholar
  7. 7.
    Higgins KM, Mandell DL, Govindaraj S, et al. The role of intraoperative rapid parathyroid hormone monitoring for predicting thyroidectomy-related hypocalcemia. Arch Otolaryngol Head Neck Surg 2004, 130: 63–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Moriyama T, Yamashita H, Noguchi S, et al. Intraoperative parathyroid hormone assay in patients with Graves’ disease for prediction of postoperative tetany. World J Surg 2005, 29: 1282–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Del Rio P, Arcuri MF, Ferreri G, Sommaruga L, Sianesi M. The utility of serum PTH assessment 24 hours after total thyroidectomy. Otolaryngol Head Neck Surg 2005, 132: 584–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Bentrem DJ, Rademaker A, Angelos P. Evaluation of serum calcium levels in predicting hypoparathyroidism after total/ near-total thyroidectomy or parathyroidectomy. Am Surg 2001, 67: 249–51; discussion 251-2.PubMedGoogle Scholar
  11. 11.
    Miccoli P, Berti P, Materazzi G, Minuto M, Barellini L. Minimally invasive video-assisted thyroidectomy: five years of experience. J Am Coll Surg 2004, 199: 243–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Al-Suliman NN, Ryttov NF, Qvist N, Blichert-Toft M, Graversen HP. Experience in a specialist thyroid surgery unit: a demographic study, surgical complications and outcome. Eur J Surg 1997, 163: 13–20.PubMedGoogle Scholar
  13. 13.
    Wilson RB, Erskine C, Crowe PJ. Hypomagnesemia and hypocalcemia after thyroidectomy: prospective study. World J Surg 2000, 24: 722–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Demeester-Mirkine N, Hooghe L, Van Geertruyden J, De Maertelaer V. Hypocalcemia after thyroidectomy. Arch Surg 1992, 127: 854–8.PubMedCrossRefGoogle Scholar
  15. 15.
    McHenry CR, Speroff T, Wentworth D, Murphy T. Risk factors for postthyroidectomy hypocalcemia. Surgery 1994, 116: 641–8.PubMedGoogle Scholar
  16. 16.
    Bergameschi R, Becaouarn G, Ronceray J, Arnaud JP. Morbidity of thyroid surgery. Am J Surg 1998, 176: 71–5.CrossRefGoogle Scholar
  17. 17.
    Pattou F, Combemale F, Fabre S, et al. Hypocalcemia after thyroid surgery: incidence and prediction of outcome. World J Surg 1998, 22: 718–24.PubMedCrossRefGoogle Scholar
  18. 18.
    Abboud B, Sargi Z, Akkam M, Sleilaty F. Risk factors for post-thyroidectomy hypocalcemia. J Am Coll Surg 2002, 195: 456–61.PubMedCrossRefGoogle Scholar
  19. 19.
    Warren FM, Andersen PE, Wax MK, Cohen JI. Intraoperative parathyroid hormone levels in thyroid and parathyroid surgery. Laryngoscope 2002, 112: 1866–70.PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2007

Authors and Affiliations

  • P. Miccoli
    • 1
  • M. N. Minuto
    • 1
    Email author
  • E. Panicucci
    • 2
  • F. Cetani
    • 3
  • J. D’Agostino
    • 1
  • E. Vignali
    • 3
  • A. Picone
    • 3
  • C. Marcocci
    • 3
  • P. Berti
    • 1
  1. 1.Department of SurgeryUniversity of PisaItaly
  2. 2.Department of Experimental PathologyUniversity of PisaItaly
  3. 3.Department of EndocrinologyUniversity of PisaItaly

Personalised recommendations