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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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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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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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