Skip to main content

Advertisement

SpringerLink
Log in

Hypocalcaemia and Parathyroid Hormone Assay Following Total Thyroidectomy: Predicting the Future

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Ambulatory surgery (23:59-hour hospital stay) is gaining popularity in endocrine surgery. Hypocalcaemia is common following total thyroidectomy. Identifying patients with low risk of hypocalcaemia may facilitate early discharge (24-hour stay).

Methods

We conducted a prospective study including all patients undergoing total thyroidectomy. Blood samples were taken immediately following skin closure and the following morning for parathyroid hormone (PTH) and calcium measurement. Calcium supplements were routinely given when serum calcium was below 2.0 mmol/l.

Results

Thirty patients (27 females, 3 males) underwent total thyroidectomy (including 4 nodal dissection) for multinodular goitre (14), Graves’ disease (11), papillary (4) and follicular (1) thyroid carcinoma. Twelve patients developed symptomatic transient hypocalcaemia. Based on morning calcium of <2.0 mmol/l as trigger for calcium supplementation, 8 patients received calcium supplement with 4 false negatives, resulting in a specificity of 94.4%, sensitivity of 66.7%, positive predictive value (PPV) of 88.9% and negative predictive value (NPV) of 81%. Based on PTH levels (<1.5 pmol/l) immediately following skin closure, 11 patients would receive calcium supplement, with 1 false negative resulting in a specificity of 83.3%, sensitivity of 91.7%, PPV of 78.6% and NPV of 93.8%. If supplementation is based on PTH levels (<1.5 pmol/l) immediately following skin closure and morning calcium level (<2.0 mmol/l), all 12 symptomatic patients will be correctly treated, with 4 false positives resulting in a combined specificity of 77.8%, sensitivity of 100%, PPV of 75% and NPV of 100%.

Conclusions

Combining the immediate postoperation PTH levels (<1.5 pmol/l) and morning serum calcium (<2.0 mmol/l) can accurately identify patients at risk of hypocalcaemia following total thyroidectomy, allowing safe, early discharge.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1.
Figure 2.
Figure 3.

Similar content being viewed by others

References

  1. National Health Service activity for sick and disabled people: accident and emergency, and acute out-patients and day cases 1981–1999: A National Statistics Publication; 2001

  2. Lam A, Kerr PD. Parathyroid hormone: an early predictor of postthyroidectomy hypocalcemia. Laryngoscope 2003;113(12):2196–2200

    Article  PubMed  Google Scholar 

  3. Richards ML, Bingener-Casey J, Pierce D, et al. Intraoperative parathyroid hormone assay: an accurate predictor of symptomatic hypocalcemia following thyroidectomy. Arch Surg 2003;138(6):632–635; discussion 635–636

    Article  PubMed  Google Scholar 

  4. Warren FM, et al. Perioperative parathyroid hormone levels in thyroid surgery: preliminary report. Laryngoscope 2004;114(4):689–693

    Article  PubMed  Google Scholar 

  5. Payne RJ, Hier MP, Tamilia M, et al. Same-day discharge after total thyroidectomy: the value of 6-hour serum parathyroid hormone and calcium levels. Head Neck 2005;27(1):1–7

    Article  PubMed  Google Scholar 

  6. Lo CY, Luk JM, Tam SC. Applicability of intraoperative parathyroid hormone assay during thyroidectomy. Ann Surg 2002;236(5):564–569

    Article  PubMed  Google Scholar 

  7. de Roy van Zuidewijn DB, et al. Complications of thyroid surgery. Ann Surg Oncol 1995;2(1):56–60

    Article  Google Scholar 

  8. Bourrel C, Uzzan B, Tison P, et al. Transient hypocalcemia after thyroidectomy. Ann Otol Rhinol Laryngol 1993;102(7):496–501

    CAS  PubMed  Google Scholar 

  9. Smith MA, Jarosz H, Hessel P, et al. Parathyroid autotransplantation in total thyroidectomy. Am Surg 1990;56(7):404–406

    CAS  PubMed  Google Scholar 

  10. Wingert DJ, Friesen SR, Iliopoulos JI, et al. Post-thyroidectomy hypocalcemia. Incidence and risk factors. Am J Surg 1986;152(6):606–610

    Article  CAS  PubMed  Google Scholar 

  11. Scanlon EF, et al. The morbidity of total thyroidectomy. Arch Surg 1981;116(5):568–571

    CAS  PubMed  Google Scholar 

  12. McHenry CR. “Same-day” thyroid surgery: an analysis of safety, cost savings, and outcome. Am Surg 1997;63(7):586–589; discussion 589–590

    CAS  PubMed  Google Scholar 

  13. Testini M, Nacchiero M, Miniello S, et al. One-day vs standard thyroidectomy. A perspective study of feasibility. Minerva Endocrinol 2002;27(3):225–229

    CAS  PubMed  Google Scholar 

  14. Pattou F, Combemale F, Fabre S, et al. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 1998;22(7):718–724

    Article  CAS  PubMed  Google Scholar 

  15. Glinoer D, et al. Clinical aspects of early and late hypocalcaemia after thyroid surgery. Eur J Surg Oncol 2000;26(6):571–577

    Article  CAS  PubMed  Google Scholar 

  16. Bergamaschi R. Morbidity of thyroid surgery. Am J Surg 1998;176(1):71–75

    Article  CAS  PubMed  Google Scholar 

  17. Moore FD Jr. 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 1994;178(1):11–16

    PubMed  Google Scholar 

  18. Bove A, Bongarzoni G, Dragani G, et al. Should female patients undergoing parathyroid-sparing total thyroidectomy receive routine prophylaxis for transient hypocalcemia? Am Surg 2004;70(6):533–536

    CAS  PubMed  Google Scholar 

  19. Bellantone R, Lombardi CP, Raffaelli M, et al. Is routine supplementation therapy (calcium and vitamin D) useful after total thyroidectomy? Surgery 2002;132(6):1109–1112; discussion 1112–1113

    Article  PubMed  Google Scholar 

  20. Mazzaferri EL, Young RL, Oertel JE, et al. Papillary thyroid carcinoma: the impact of therapy in 576 patients. Medicine (Baltimore) 1977;56(3):171–196

    CAS  Google Scholar 

  21. Burkey SH, van Heerden JA, Thompson GB, et al. Reexploration for symptomatic hematomas after cervical exploration. Surgery 2001;130(6):914–920

    Article  CAS  PubMed  Google Scholar 

  22. Adams J, et al. Early postoperative calcium levels as predictors of hypocalcemia. Laryngoscope 1998;108(12):1829–1831

    Article  PubMed  Google Scholar 

  23. Demeester-Mirkine N, Hooghe L, Van Geertruyden J, De Maertelaer V. Hypocalcemia after thyroidectomy. Arch Surg 1992;127(7):854–885

    CAS  PubMed  Google Scholar 

  24. Mittendorf EA, McHenry CR. Thyroidectomy for selected patients with thyrotoxicosis. Arch Otolaryngol Head Neck Surg 2001;127(1):61–65

    CAS  PubMed  Google Scholar 

  25. Burnett HF, Mabry CD, Westbrook KC. Hypocalcemia after thyroidectomy: mechanisms and management. South Med J 1977;70(9):1045–1048

    CAS  PubMed  Google Scholar 

  26. Giovannini C, Cristaldi M, Pronio AM, et al. Parathyroid functional assessment in patients following total thyroidectomy for thyroid malignancies. J Exp Clin Cancer Res 1998;17(1):117–119

    CAS  PubMed  Google Scholar 

  27. Sturniolo G, Lo Schiavo MG, Tonante A, et al. Hypocalcemia and hypoparathyroidism after total thyroidectomy: a clinical biological study and surgical considerations. Int J Surg Investig 2000;2(2):99–105

    CAS  PubMed  Google Scholar 

  28. See AC, Soo KC. Hypocalcaemia following thyroidectomy for thyrotoxicosis. Br J Surg 1997;84(1):95–97

    Article  CAS  PubMed  Google Scholar 

  29. Sawers JS, Kellett HA, Brown NS, et al. Does calcitonin cause hypocalcaemia after thyroidectomy? Br J Surg 1982;69(8):456–458

    CAS  PubMed  Google Scholar 

  30. McHenry CR, et al. Risk factors for postthyroidectomy hypocalcemia. Surgery 1994;116(4):641–7; discussion 647–648

    CAS  PubMed  Google Scholar 

  31. Michie W, Duncan T, Hamer-Hodges DW, et al. Mechanism of hypocalcaemia after thyroidectomy for thyrotoxicosis. Lancet 1971;1(7698):508–514

    Article  CAS  PubMed  Google Scholar 

  32. 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(3):249–251; discussion 251–22

    CAS  PubMed  Google Scholar 

  33. Lombardi CP, Raffaelli M, Princi P, et al. Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurement. Surgery 2004;136(6):1236–1241

    Article  PubMed  Google Scholar 

  34. Lindblom P, Westerdahl J, Bergenfelz A. Low parathyroid hormone levels after thyroid surgery: a feasible predictor of hypocalcemia. Surgery 2002;131(5):515–520

    Article  PubMed  Google Scholar 

  35. Curley IR, Wheeler MH, Aston JP, et al. Studies in patients with hyperparathyroidism using a new two-site immunochemiluminometric assay for circulating intact (1-84) parathyroid hormone. Surgery 1987;102(6):926–931

    CAS  PubMed  Google Scholar 

  36. Bieglmayer C, Prager G, Niederle B. Kinetic analyses of parathyroid hormone clearance as measured by three rapid immunoassays during parathyroidectomy. Clin Chem 2002;48(10):1731–1738

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Endocrine Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK

    S. Price BSc, RGN & D. Scott-Coombes MD, FRCS

  2. Department of Surgery, Frenchay Hospital, Frenchay Park, Bristol, BS16 1LE, UK

    C. Wong PhD, FRCS

Authors
  1. C. Wong PhD, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Price BSc, RGN
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Scott-Coombes MD, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Scott-Coombes MD, FRCS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wong, C., Price, S. & Scott-Coombes, D. Hypocalcaemia and Parathyroid Hormone Assay Following Total Thyroidectomy: Predicting the Future. World J. Surg. 30, 825–832 (2006). https://doi.org/10.1007/s00268-005-0478-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-005-0478-y

Keywords

Search

Navigation