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Necessity of therapy for post-thyroidectomy hypocalcaemia: a multi-centre experience

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Abstract

Purpose

Hypoparathyroidism is one of the most common and most feared complications of total thyroidectomy (TT). The aim of this study is to detect possible markers that may facilitate early tracing of hypocalcaemia-prone patients in order to reduce clinical cost by optimizing patient discharge and to avoid unnecessary treatment.

Methods

Over an 18-month period, 995 patients, 23 % male and 77 % female, aged 52.9 ± 13.4 years, underwent TT in ten Lombardy hospitals. The following parameters were analyzed: calcaemia before and 12–24 and 48 h after surgery, pre- and post-operative parathyroid hormone (PTH) at 24 h and pre-operative 25OH vitamin D.

Results

Mortality was nil and morbidity was 22.4 %. Mean 24-h calcaemia and PTH were 2.17 ± 0.15 mmol/l and 31.81 ± 20.35 pg/ml, respectively; mean 24-h PTH decay was 36.7 ± 34.12 %. Four hundred seventy-three (47.5 %) patients were hypocalcaemic at discharge; 142 of whom had transient hypoparathyroidism that became permanent in 27. Patients developing hypocalcaemia had significantly higher values of PTH and calcium decay. At multiple logistic regression, only 24-h calcium decay, PTH drop and the presence of symptoms and parathyroid auto-grafting were significantly related to hypoparathyroidism. The association of these factors had a 99.2 % negative predictive value (NPV) for the development of hypoparathyroidism. A 70 % PTH drop had a 93.75 NPV for transient hypoparathyroidism. A 12 % calcaemia decay had a 95.7 NPV for hypoparathyroidism.

Conclusions

Hypocalcaemic asymptomatic patients with less than 70 % PTH and 12 % calcaemia decay may be safely discharged without treatment. Symptomatic patients and those with parathyroid grafting should receive calcium and vitamin D.

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References

  1. Bergenfelz A, Jansson S, Kristoffersson A et al (2008) Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbeck’s Arch Surg / Deut Ges Chirurgie 393:667–673

    Article  CAS  Google Scholar 

  2. Grodski S, Serpell J (2008) Evidence for the role of perioperative PTH measurement after total thyroidectomy as a predictor of hypocalcemia. World J Surg 32:1367–1373

    Article  PubMed  Google Scholar 

  3. Sitges-Serra A, Ruiz S, Girvent M et al (2010) Outcome of protracted hypoparathyroidism after total thyroidectomy. Br J Surg 97:1687–1695

    Article  CAS  PubMed  Google Scholar 

  4. Lazard DS, Godiris-Petit G, Wagner I et al (2012) Early detection of hypocalcemia after total/completion thyroidectomy: routinely usable algorithm based on serum calcium level. World J Surg 36:2590–2597

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. 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 1023-1015

    Article  PubMed  Google Scholar 

  7. 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 1112-1103

    Article  PubMed  Google Scholar 

  8. Wang TS, Cheung K, Roman SA et al (2011) To supplement or not to supplement: a cost-utility analysis of calcium and vitamin D repletion in patients after thyroidectomy. Ann Surg Oncol 18:1293–1299

    Article  PubMed  Google Scholar 

  9. Docimo G, Tolone S, Pasquali D et al (2012) Role of pre and post-operative oral calcium and vitamin D supplements in prevention of hypocalcemia after total thyroidectomy Il. G Chir 33:374–378

    CAS  PubMed  Google Scholar 

  10. Delbridge L (2012) Selective rather than routine: using sound clinical judgment. Arch Surg (Chicago, Ill : 1960) 147:344

    Article  Google Scholar 

  11. Raffaelli M, De Crea C, Carrozza C et al (2012) Combining early postoperative parathyroid hormone and serum calcium levels allows for an efficacious selective post-thyroidectomy supplementation treatment. World J Surg 36:1307–1313

    Article  PubMed  Google Scholar 

  12. Landry CS, Grubbs EG, Hernandez M et al (2012) Predictable criteria for selective, rather than routine, calcium supplementation following thyroidectomy. Arch Surg (Chicago, Ill: 1960) 147:338–344

    Google Scholar 

  13. Cayo AK, Yen TW, Misustin SM et al (2012) Predicting the need for calcium and calcitriol supplementation after total thyroidectomy: results of a prospective, randomized study. Surgery 152:1059–1067

    Article  PubMed  Google Scholar 

  14. Tredici P, Grosso E, Gibelli B et al (2011) Identification of patients at high risk for hypocalcemia after total thyroidectomy. Acta Otorhinolaryngol Ital: Organo Ufficiale Soc Ital Otorinolaringol Chir CervicoFac 31:144–148

    CAS  Google Scholar 

  15. Salinger EM, Moore JT (2013) Perioperative indicators of hypocalcemia in total thyroidectomy: the role of vitamin D and parathyroid hormone. Am J Surg 206:876–881, discussion 881-872

    Article  PubMed  Google Scholar 

  16. Toniato A, Boschin IM, Piotto A et al (2008) Thyroidectomy and parathyroid hormone: tracing hypocalcemia-prone patients. Am J Surg 196:285–288

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  18. Hallgrimsson P, Nordenstrom E, Bergenfelz A et al (2012) Hypocalcaemia after total thyroidectomy for Graves’ disease and for benign atoxic multinodular goitre. Langenbeck’s Arch Surg / Dtsch Ges Chir 397:1133–1137

    Article  Google Scholar 

  19. Edafe O, Antakia R, Laskar N et al (2014) Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg 101:307–320

    Article  CAS  PubMed  Google Scholar 

  20. Snyder S, Govednik C, Lairmore T et al (2013) Total thyroidectomy as primary definitive treatment for Graves’ hyperthyroidism. Am Surgeon 79:1283–1288

    PubMed  Google Scholar 

  21. Kirkby-Bott J, Markogiannakis H, Skandarajah A et al (2011) Preoperative vitamin D deficiency predicts postoperative hypocalcemia after total thyroidectomy. World J Surg 35:324–330

    Article  PubMed  Google Scholar 

  22. Falcone TE Noordzij JP, Jalisi S et al (2013) Preoperative vitamin D deficiency as a predictor of post-total-thyroidectomy hypocalcemia. Otolaryngology Head Neck Surg 149:186

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Acknowledgments

The authors thank Mrs. Kimberly Davies for her precious help with language.

Conflicts of interest

This study has no potential conflict of interest.

Compliance with ethical standards

This study involved human participants. Informed consent was obtained by participating patients.

Authors’ contributions

Study conception and design were by De Pasquale L, Sartori PV, Vicentini L, Beretta E, Boniardi M, Leopaldi E, Gini P, La Manna L, Cozzaglio L, Steffano GB, Ghilardi G, and Morenghi E. Acquisition of data was by De Pasquale L, Sartori PV, Vicentini L, Beretta E, Boniardi M, Leopaldi E, Gini P, La Manna L, Cozzaglio L, Steffano GB, Andreani S, Badiali S, Cantoni GM, Galimberti A, Ghilardi G, Gusmeroli M, Maggiore R, Pauna J, Poggi L, and Testa V. Analysis and interpretation of data were done by Morenghi E, Sartori PV, Gusmeroli M, Maggiore R, and Testa V. Drafting of the manuscript was done by De Pasquale L, Sartori PV, and Gini P. The manuscript was critically revised by Vicentini L, Beretta E, Boniardi M, Leopaldi E, and Ghilardi G.

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Authors and Affiliations

  1. Endocrine and Breast Surgery Unit, General Surgery Department, Milan University, San Paolo Hospital, Milan, Italy

    L. De Pasquale & G. Ghilardi

  2. Surgical Department, Desio Hospital, Desio, Monza and Brianza, Italy

    P. V. Sartori

  3. Endocrine Surgery Unit, General and Emergency Surgical Department, Fondazione IRCCS Cà Granda, Policlinico Hospital, Milan, Italy

    L. Vicentini, S. Badiali, G. M. Cantoni & L. Poggi

  4. Endocrine Surgery Unit, San Raffaele Hospital, Milan, Italy

    E. Beretta, R. Maggiore & V. Testa

  5. General and Mininvasive Surgery Department, Niguarda Hospital, Milan, Italy

    M. Boniardi, S. Andreani & J. Pauna

  6. Endocrine Surgery Unit, Surgical Department, Sacco Hospital, Milan, Italy

    E. Leopaldi

  7. Surgical Department, Legnano Hospital, Legnano, Milan, Italy

    P. Gini & A. Galimberti

  8. General Surgery Unit, Mini-invasive Section, IRCCS Fondazione Salvatore Maugeri, Pavia, Italy

    L. La Manna

  9. General and Oncologic Surgical Unit, Humanitas Clinical Institute, Rozzano, Milan, Italy

    L. Cozzaglio & M. Gusmeroli

  10. Biostatistics Unit, Humanitas Clinical Institute, Rozzano, Milan, Italy

    E. Morenghi

  11. Endocrine and Breast Surgery Unit, 1st Surgical Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy

    G. B. Steffano

Authors
  1. L. De Pasquale
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  2. P. V. Sartori
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  3. L. Vicentini
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  4. E. Beretta
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  5. M. Boniardi
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  6. E. Leopaldi
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  7. P. Gini
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  8. L. La Manna
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  9. L. Cozzaglio
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  10. G. B. Steffano
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  11. S. Andreani
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  12. S. Badiali
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  13. G. M. Cantoni
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  14. A. Galimberti
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  15. G. Ghilardi
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  16. M. Gusmeroli
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  17. R. Maggiore
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  18. E. Morenghi
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  19. J. Pauna
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  20. L. Poggi
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  21. V. Testa
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Corresponding author

Correspondence to P. V. Sartori.

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De Pasquale, L., Sartori, P.V., Vicentini, L. et al. Necessity of therapy for post-thyroidectomy hypocalcaemia: a multi-centre experience. Langenbecks Arch Surg 400, 319–324 (2015). https://doi.org/10.1007/s00423-015-1292-0

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  • DOI: https://doi.org/10.1007/s00423-015-1292-0

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