Advertisement

World Journal of Surgery

, Volume 32, Issue 7, pp 1367–1373 | Cite as

Evidence for the Role of Perioperative PTH Measurement after Total Thyroidectomy as a Predictor of Hypocalcemia

  • Simon GrodskiEmail author
  • Jonathan Serpell
Article

Abstract

Background

Total thyroidectomy is now accepted worldwide as the standard surgical procedure for the management of benign bilateral nodular thyroid disease. Hypocalcemia is the most common complication of that procedure and a variety of strategies for diagnosing and managing post-thyroidectomy hypocalcemia have been advocated. Increasingly, the use of intact parathyroid hormone (PTH) has been utilized to try to predict those patients at risk of developing post-thyroidectomy hypocalcemia.

Methods

A Medline search of English language literature was performed and we reviewed the evidence in relation to the following three issues: the accuracy of PTH in predicting hypocalcemia, the optimal timing for measuring PTH, and the routine use of oral calcium supplements.

Results

Post-thyroidectomy PTH levels accurately predict hypocalcemia but lack 100% accuracy. Progressive and severe hypocalcemia is unlikely in the setting of a normal PTH level and hence PTH can be cautiously used to facilitate discharge within 24 h for many patients. In addition, PTH levels can be used to implement early treatment with calcium and/or vitamin D supplements to reduce the incidence and severity of hypocalcemia. A single PTH measurement taken any time from 10 min to several hours postoperative will provide equally accurate results for predicting post-thyroidectomy hypocalcemia. Routine use of oral calcium supplements may reduce the incidence and severity of post-thyroidectomy hypocalcemia.

Conclusion

Postoperative PTH can be used to stratify the risk of patients developing hypocalcemia after thyroidectomy. In addition, the routine use of oral calcium supplements can lead to decreased incidence and severity of post-thyroidectomy hypocalcemia. Protocols based on PTH and the routine use of oral calcium supplements can lead to improved patient outcomes after thyroidectomy.

Keywords

Total Thyroidectomy Receiver Operator Characteristic Oral Calcium Endocrine Surgeon Postoperative Hypocalcemia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Pattou F, Combemale F, Fabre S et al (1998) Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 22:718–724PubMedCrossRefGoogle Scholar
  2. 2.
    Lo Gerfo P, Gates R, Gazetas P (1991) Outpatient and short-stay thyroid surgery. Head Neck 13:97–101PubMedCrossRefGoogle Scholar
  3. 3.
    Mowschenson PM, Hodin RA (1995) Outpatient thyroid and parathyroid surgery: a prospective study of feasibility, safety, and costs. Surgery 118:1051–1053; discussion 1053–1054PubMedCrossRefGoogle Scholar
  4. 4.
    McHenry CR (1997) “Same-day” thyroid surgery: an analysis of safety, cost savings, and outcome. Am Surg 63:586–589; discussion 589–590PubMedGoogle Scholar
  5. 5.
    Schwartz AE, Clark OH, Ituarte P et al (1998) Therapeutic controversy: Thyroid surgery—the choice. J Clin Endocrinol Metab 83:1097–1105PubMedCrossRefGoogle Scholar
  6. 6.
    Heinrich S, Schafer M, Rousson V et al (2006) Evidence-based treatment of acute pancreatitis: a look at established paradigms. Ann Surg 243:154–168PubMedCrossRefGoogle Scholar
  7. 7.
    Alia P, Moreno P, Rigo R et al (2007) Postresection parathyroid hormone and parathyroid hormone decline accurately predict hypocalcemia after thyroidectomy. Am J Clin Pathol 127:592–597PubMedCrossRefGoogle Scholar
  8. 8.
    Di Fabio F, Casella C, Bugari G et al (2006) Identification of patients at low risk for thyroidectomy-related hypocalcemia by intraoperative quick PTH. World J Surg 30:1428–1433PubMedCrossRefGoogle Scholar
  9. 9.
    Lo CY, Luk JM, Tam SC (2002) Applicability of intraoperative parathyroid hormone assay during thyroidectomy. Ann Surg 236:564–569PubMedCrossRefGoogle Scholar
  10. 10.
    Sywak MS, Palazzo FF, Yeh M et al (2007) Parathyroid hormone assay predicts hypocalcaemia after total thyroidectomy. ANZ J Surg 77:667–670PubMedCrossRefGoogle Scholar
  11. 11.
    Grodski S, Farrell S (2007) Early postoperative PTH levels as a predictor of hypocalcaemia and facilitating safe early discharge after total thyroidectomy. Asian J Surg 30:178–182PubMedCrossRefGoogle Scholar
  12. 12.
    Khafif A, Pivoarov A, Medina JE et al (2006) Parathyroid hormone: a sensitive predictor of hypocalcemia following total thyroidectomy. Otolaryngol Head Neck Surg 134:907–910PubMedCrossRefGoogle Scholar
  13. 13.
    Wong C, Price S, Scott-Coombes D (2006) Hypocalcaemia and parathyroid hormone assay following total thyroidectomy: predicting the future. World J Surg 30:825–832PubMedCrossRefGoogle Scholar
  14. 14.
    McLeod IK, Arciero C, Noordzij JP et al (2006) The use of rapid parathyroid hormone assay in predicting postoperative hypocalcemia after total or completion thyroidectomy. Thyroid 16:259–265CrossRefGoogle Scholar
  15. 15.
    Ghaheri BA, Liebler SL, Andersen PE et al (2006) Perioperative parathyroid hormone levels in thyroid surgery. Laryngoscope 116:518–521PubMedCrossRefGoogle Scholar
  16. 16.
    Lombardi CP, Raffaelli M, Princi P et al (2006) Parathyroid hormone levels 4 hours after surgery do not accurately predict post-thyroidectomy hypocalcemia. Surgery 140:1016–1023; discussion 1023–1015PubMedCrossRefGoogle Scholar
  17. 17.
    Vescan A, Witterick I, Freeman J (2005) Parathyroid hormone as a predictor of hypocalcemia after thyroidectomy. Laryngoscope 115:2105–2108PubMedCrossRefGoogle Scholar
  18. 18.
    Soon PS, Magarey CJ, Campbell P et al (2005) Serum intact parathyroid hormone as a predictor of hypocalcaemia after total thyroidectomy. ANZ J Surg 75:977–980PubMedCrossRefGoogle Scholar
  19. 19.
    Moriyama T, Yamashita H, Noguchi S et al (2005) Intraoperative parathyroid hormone assay in patients with Graves’ disease for prediction of postoperative tetany. World J Surg 29:1282–1287PubMedCrossRefGoogle Scholar
  20. 20.
    Scurry WC Jr, Beus KS, Hollenbeak CS et al (2005) Perioperative parathyroid hormone assay for diagnosis and management of postthyroidectomy hypocalcemia. Laryngoscope 115:1362–1366PubMedCrossRefGoogle Scholar
  21. 21.
    Quiros RM, Pesce CE, Wilhelm SM et al (2005) Intraoperative parathyroid hormone levels in thyroid surgery are predictive of postoperative hypoparathyroidism and need for vitamin D supplementation. Am J Surg 189:306–309PubMedCrossRefGoogle Scholar
  22. 22.
    Payne RJ, Hier MP, Cote V et al (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 34:323–327PubMedCrossRefGoogle Scholar
  23. 23.
    Payne RJ, Tewfik MA, Hier MP et al (2005) Benefits resulting from 1- and 6-hour parathyroid hormone and calcium levels after thyroidectomy. Otolaryngol Head Neck Surg 133:386–390PubMedCrossRefGoogle Scholar
  24. 24.
    Payne RJ, Hier MP, Tamilia M et al (2005) Same-day discharge after total thyroidectomy: the value of 6-hour serum parathyroid hormone and calcium levels. Head Neck 27:1–7PubMedCrossRefGoogle Scholar
  25. 25.
    Del Rio P, Arcuri MF, Ferreri G et al (2005) The utility of serum PTH assessment 24 hours after total thyroidectomy. Otolaryngol Head Neck Surg 132:584–586PubMedCrossRefGoogle Scholar
  26. 26.
    Warren FM, Andersen PE, Wax MK et al (2004) Perioperative parathyroid hormone levels in thyroid surgery: preliminary report. Laryngoscope 114:689–693PubMedCrossRefGoogle Scholar
  27. 27.
    Higgins KM, Mandell DL, Govindaraj S et al (2004) The role of intraoperative rapid parathyroid hormone monitoring for predicting thyroidectomy-related hypocalcemia. Arch Otolaryngol Head Neck Surg 130:63–67PubMedCrossRefGoogle Scholar
  28. 28.
    Lombardi CP, Raffaelli M, Princi P et al (2004) Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurement. Surgery 136:1236–1241PubMedCrossRefGoogle Scholar
  29. 29.
    Lam A, Kerr PD (2003) Parathyroid hormone: an early predictor of postthyroidectomy hypocalcemia. Laryngoscope 113:2196–2200PubMedCrossRefGoogle Scholar
  30. 30.
    Richards ML, Bingener-Casey J, Pierce D et al (2003) Intraoperative parathyroid hormone assay: an accurate predictor of symptomatic hypocalcemia following thyroidectomy. Arch Surg 138:632–635; discussion 635–636PubMedCrossRefGoogle Scholar
  31. 31.
    Payne RJ, Hier MP, Tamilia M et al (2003) Postoperative parathyroid hormone level as a predictor of post-thyroidectomy hypocalcemia. J Otolaryngol 32:362–367PubMedCrossRefGoogle Scholar
  32. 32.
    Warren FM, Andersen PE, Wax MK et al (2002) Intraoperative parathyroid hormone levels in thyroid and parathyroid surgery. Laryngoscope 112:1866–1870PubMedCrossRefGoogle Scholar
  33. 33.
    Lindblom P, Westerdahl J, Bergenfelz A (2002) Low parathyroid hormone levels after thyroid surgery: a feasible predictor of hypocalcemia. Surgery 131:515–520PubMedCrossRefGoogle Scholar
  34. 34.
    Australian Endocrine Surgeons (2007) Guidelines AES06/01. Postoperative parathyroid hormone measurement and early discharge after total thyroidectomy: analysis of Australian data and management recommendations. ANZ J Surg 77:199–202CrossRefGoogle Scholar
  35. 35.
    Roh JL, Park CI (2006) Intraoperative parathyroid hormone assay for management of patients undergoing total thyroidectomy. Head Neck 28:990–997PubMedCrossRefGoogle Scholar
  36. 36.
    Bellantone R, Lombardi CP, Raffaelli M et al (2002) Is routine supplementation therapy (calcium and vitamin D) useful after total thyroidectomy? Surgery 132:1109–1112; discussion 1112–1103PubMedCrossRefGoogle Scholar
  37. 37.
    Roh JL, Park CI (2006) Routine oral calcium and vitamin D supplements for prevention of hypocalcemia after total thyroidectomy. Am J Surg 192:675–678PubMedCrossRefGoogle Scholar
  38. 38.
    Moore FD Jr (1994) Oral calcium supplements to enhance early hospital discharge after bilateral surgical treatment of the thyroid gland or exploration of the parathyroid glands. J Am Coll Surg 178:11–16PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  1. 1.The Alfred HospitalMonash University Endocrine Surgery UnitMelbourneAustralia
  2. 2.Monash University Endocrine Surgery Unit, c/o Suite 56, Cabrini HospitalMelbourneAustralia

Personalised recommendations