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Which criterion of intraoperative iPTH assay is the most accurate in prediction of true serum calcium levels after thyroid surgery?

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Abstract

Background and aims

Intraoperative quick intact parathyroid hormone (iPTH) assay (IOPTH) has become a valuable adjunct in parathyroid surgery reliably predicting cure from hyperparathyroid state. Similarly to parathyroid surgery, the accuracy of the assay in predicting postoperative calcemia after thyroid surgery is related to blood sample timing and the criteria applied with no guidelines widely accepted, so far. This study compares different IOPTH criteria in predicting hypoparathyroidism-related hypocalcemia after thyroid surgery.

Materials and methods

The study included 200 consecutive patients undergoing total thyroidectomy. Three blood samples for IOPTH were taken in each patient: preoperatively—baseline (BL), at the end of surgery—skin closure (SC), and at 4 h postoperatively (4H). Serum calcium was routinely monitored at 4, 12, 24, 48, and 72 h postoperatively. The incidence and severity of hypocalcemia and related symptoms were matched to IOPTH results. The following criteria were tested: A, greater than 50% drop from BL at SC; B, greater than 70% drop from BL at SC; C, greater than 50% drop from BL at 4H; D, greater than 70% drop from BL at 4H; E, serum iPTH less than 15 pg/ml at SC; F, serum iPTH less than 10 pg/ml at SC; G, serum iPTH less than 15 pg/ml at 4H; H, serum iPTH less than 10 pg/ml at 4H. The accuracy of the tested criteria was calculated in predicting serum calcium level less than 2.0 mmol/l at any point after thyroidectomy.

Results

Tested criteria had the following value in predicting serum calcium level less than 2.0 mmol/l after thyroidectomy (sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy, respectively): A (60, 89, 38, 95, and 86%), B (80, 93, 57, 98, and 92%), C (70, 90, 44, 96, and 88%), D (85, 95, 65, 98, and 94%), E (80, 91, 50, 98, and 90%), F (90, 95, 69, 99, and 95%), G (90, 95, 70, 99, and 95%), H (95, 99, 90, 99, and 98%).

Conclusions

The criterion of iPTH serum level less than 10 pg/ml at 4 h postoperatively has the highest accuracy in predicting serum calcium level below 2.0 mmol/l after total thyroidectomy when compared with the other criteria.

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References

  1. Sofferman RA, Randolph GW (2003) Intraoperative parathyroid hormone assessment during parathyroidectomy. In: Randolph GW (ed) Surgery of the thyroid and parathyroid glands, 1st edn. Saunders, Philadelphia, pp 557–563

    Google Scholar 

  2. Mittendorf EA, Merlino JI, McHenry CR (2004) Post-parathyroidectomy hypocalcemia: incidence, risk factors, and management. Am Surg 70:114–120

    PubMed  Google Scholar 

  3. Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H (2003) The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery 133:180–185

    Article  PubMed  Google Scholar 

  4. Kihara M, Miyauchi A, Kontani K, Yamauchi A, Yokomise H (2005) Recovery of parathyroid function after total thyroidectomy: long-term follow-up study. ANZ J Surg 75:532–536

    Article  PubMed  Google Scholar 

  5. Chia SH, Weisman RA, Tieu D, Kelly C, Dillmann WH, Orloff LA (2006) Prospective study of perioperative factors predicting hypocalcemia after thyroid and parathyroid surgery. Arch Otolaryngol Head Neck Surg 132:41–45

    Article  PubMed  Google Scholar 

  6. Lombardi CP, Raffaelli M, Princi P, Santini S, Boscherini M, De Crea C, Traini E, D’Amore AM, Carrozza C, Zuppi C, Bellantone R (2004) Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurement. Surgery 136:1236–1241

    Article  PubMed  Google Scholar 

  7. Yamashita H, Murakami T, Noguchi S, Shiiba M, Watanabe S, Uchino S, Kawamoto H, Toda M, Murakami N (1999) Postoperative tetany in Graves disease: Important role of vitamin D metabolites. Ann Surg 229:237–245

    Article  PubMed  CAS  Google Scholar 

  8. Gűllűoglu BM, Manukyan MN, Cingi A, Yegen C, Yalin R, Özdemir Aktan A (2005) Early prediction of normocalcemia after thyroid surgery. World J Surg 29:1288–1293

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  10. Warren FM, Andersen PE, Wax MK, Cohen JI (2002) Intraoperative parathyroid hormone levels in thyroid and parathyroid surgery. Laryngoscope 112:1866–1870

    Article  PubMed  CAS  Google Scholar 

  11. Warren FM, Andersen PE, Wax MK, Cohen JI (2004) Perioperative parathyroid hormone levels in thyroid surgery: preliminary report. Laryngoscope 114:689–693

    Article  PubMed  Google Scholar 

  12. Quiros RM, Pesce CE, Wilhelm SM, Djurcin G, Prinz RA (2005) Intraoperative parathyroid hormone levels in thyroid surgery are predictive of postoperative hypoparathyroidism and need for vitamin D supplementation. Am J Surg 189:306–309

    Article  PubMed  CAS  Google Scholar 

  13. Scurry WC, Beus KS, Hollenbeak CS, Stack BC (2005) Perioperative parathyroid hormone assay for diagnosis and management of postthyroidectomy hypocalcemia. Laryngoscope 115:1362–1366

    Article  PubMed  CAS  Google Scholar 

  14. Palazzo FF, Sywak M, Sidhu SB, Barraclough BH, Delbridge LW (2005) Parathyroid autotransplantation during total thyroidectomy—does the number of glands transplanted affect outcome? World J Surg 29:629–631

    Article  PubMed  Google Scholar 

  15. Delbridge L (2002) Parathyroid autotransplantation: an essential technique for safe thyroid surgery. ANZ J Surg 72:852–853

    Article  PubMed  Google Scholar 

  16. Lo C-Y (2002) Parathyroid autotransplantation during thyroidectomy. ANZ J Surg 72:902–907

    Article  PubMed  Google Scholar 

  17. Friedman M, Vidyasagar R, Bliznikas D, Joseph AJ (2005) Intraoperative intact parathyroid hormone level monitoring as a guide to parathyroid reimplantation after thyroidectomy. Laryngoscope 115:34–38

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Marcin Barczyński.

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Barczyński, M., Cichoń, S. & Konturek, A. Which criterion of intraoperative iPTH assay is the most accurate in prediction of true serum calcium levels after thyroid surgery?. Langenbecks Arch Surg 392, 693–698 (2007). https://doi.org/10.1007/s00423-007-0165-6

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  • DOI: https://doi.org/10.1007/s00423-007-0165-6

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