Abstract
Introduction
There has not been a universal agreement about the timings and the threshold level of PTH that can accurately predict the risk of hypocalcemia. Our study aimed to investigate the changes in the serum PTH levels at various time intervals and correlate it with the development of subsequent hypocalcemia.
Materials and methods
All patients had a pre-operative serum PTH done and were again assessed intra-operatively, at 4 h, 24 h, 72 h, and 1 month after the thyroid surgery. Absolute serum PTH value at various time points, absolute change in serum PTH values compared to pre-operative level, and relative change (percentage change) in serum PTH values compared with pre-operative levels were used to predict post-operative Hypocalcemia.
Results
49 patients were included in the study. The sensitivity and negative predictive value was 100% for serum PTH at 4 h. There was a statistically significant difference between the groups that required calcium supplementation versus the group that did not require it. The maximum relative reduction in serum PTH value with respect to the pre-operative level occurred at 4 h in the calcium supplement required group which was 82.5%. Use of combination of 4 h serum PTH and relative change at 4 h yielded the best results.
Conclusion
A combination of absolute serum PTH level at 4 h and the relative decline in serum PTH at 4 h has the highest diagnostic accuracy. The use of this combined parameter helps to reliably predict patients who would require supplementation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
References
Reeve T, Thompson NW (2000) Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg 24(8):971–975
McLeod IK, Arciero C, Noordzij JP, Stojadinovic A, Peoples G, Melder PC et al (2006) The use of rapid parathyroid hormone assay in predicting post-operative hypocalcemia after total or completion thyroidectomy. Thyroid 16(3):259–265
McHenry CR, Speroff T, Wentworth D, Murphy T (1994) Risk factors for postthyroidectomy hypocalcemia. Surgery 116(4):641–648
Abboud B, Sargi Z, Akkam M, Sleilaty F (2002) Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg 195(4):456–461
Graff AT, Miller FR, Roehm CE, Prihoda TJ (2010) Predicting hypocalcemia after total thyroidectomy: parathyroid hormone level vs. serial calcium levels. Ear Nose Throat J 89(9):462–465
Huang S-M (2012) Do we overtreat post-thyroidectomy hypocalcemia? World J Surg 36(7):1503–1508
Sianesi M, Del Rio P, Ferreri G, Arcuri MF, Medusei GM, Robuschi G (2004) Post-thyroidectomy hypocalcemia: clinical and laboratory findings. Chir Ital 56(2):169–174
Galy-Bernadoy C, Lallemant B, Chambon G, Pham HT, Reynaud C, Alovisetti C et al (2018) Parathyroid hormone assays following total thyroidectomy: is there a predictive value? Eur Thyroid J 7(1):34–38
Essa MS, Ahmad KS, Fadey MA, El-Shaer MO, Salama AMF, Zayed ME (2021) Role of perioperative parathormone hormone level assay after total thyroidectomy as a predictor of transient and permanent hypocalcemia: Prospective study. Ann Med Surg 69:102701
Barczyński M, Cichoń S, Konturek A (2007) Which criterion of intraoperative iPTH assay is the most accurate in prediction of true serum calcium levels after thyroid surgery? Langenbeck’s Arch Surg 392(6):693–698
Grodski S, Serpell J (2008) Evidence for the role of perioperative PTH measurement after total thyroidectomy as a predictor of hypocalcemia. World J Surg 32(7):1367–1373
Lombardi CP, Raffaelli M, Princi P, Santini S, Boscherini M, De Crea C et al (2004) Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurement. Surgery 136(6):1236–1241
Lombardi CP, Raffaelli M, Princi P, Dobrinja C, Carrozza C, Di Stasio E et al (2006) Parathyroid hormone levels 4 hours after surgery do not accurately predict post-thyroidectomy hypocalcemia. Surgery 140(6):1015–1016
Sywak MS, Palazzo FF, Yeh M, Wilkinson M, Snook K, Sidhu SB et al (2007) Parathyroid hormone assay predicts hypocalcaemia after total thyroidectomy. ANZ J Surg 77(8):667–670
Griffin TP, Murphy MS, Sheahan P (2014) Vitamin D and risk of post-operative hypocalcemia after total thyroidectomy. JAMA Otolaryngol Head Neck Surg 140(4):346–351
Lin Y, Ross HL, Raeburn CD, DeWitt PE, Albuja-Cruz M, Jones EL et al (2012) Vitamin D deficiency does not increase the rate of post-operative hypocalcemia after thyroidectomy. Am J Surg 204(6):884–888
Edafe O, Mech CE, Balasubramanian SP (2019) Calcium, vitamin D or recombinant parathyroid hormone for managing post-thyroidectomy hypoparathyroidism. Cochrane database Syst Rev 5(5):CD012845
Koimtzis GD, Stefanopoulos L, Giannoulis K, Papavramidis TS (2021) What are the real rates of temporary hypoparathyroidism following thyroidectomy? It is a matter of definition: a systematic review. Endocrine 73(1):1–7
Deshmukh A, Gangiti K, Pantvaidya G, Nair D, Basu S, Chaukar D et al (2018) Surgical outcomes of thyroid cancer patients in a tertiary cancer center in India. Indian J Cancer 55(1):23–32
Zhao W, You L, Hou X, Chen S, Ren X, Chen G et al (2017) The Effect of prophylactic central neck dissection on locoregional recurrence in papillary thyroid cancer after total thyroidectomy: a systematic review and meta-analysis: pCND for the locoregional recurrence of papillary thyroid cancer. Ann Surg Oncol 24(8):2189–2198
Funding
The authors have no relevant financial or non-financial interests to disclose.
Author information
Authors and Affiliations
Contributions
Study concepts: NKP. Study design: AK. Data acquisition:AK. Quality control of data and algorithms:NKP. Data analysis and interpretation: AK. Statistical analysis: VS. Manuscript preparation: AK. Manuscript editing: JB. Manuscript review: SB.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no competing interests to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article. No identification of any patients was done in the paper.
Ethical approval
The study was approved by the appropriate institutional research ethics committee (Letter No. INT/IEC/2020/000443 dt. May 17, 2020), and I certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent
Informed consent was taken before each procedure from the patients.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Kapoor, A., Panda, N.K., Sharma, V. et al. Serum PTH at 4 h after total thyroidectomy as a predictor of hypocalcemia: a prospective time frame analysis in search of evidence. Eur Arch Otorhinolaryngol 280, 3793–3800 (2023). https://doi.org/10.1007/s00405-023-07950-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-023-07950-w