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Risk reduction of hypocalcemia after thyroidectomy

Review of a clinical practice in an Irish cohort

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Summary

Background

Hypocalcemia is a well-described complication associated with total thyroidectomies. We investigated the role of early intraoperative parathyroid hormone (PTH) measurement and relative differences in PTH in predicting those patients at risk of postoperative hypocalcemia.

Methods

This was a retrospective study. Inclusion criteria were all patients undergoing completion/total thyroidectomy from March 2016 to March 2017 under a single surgeon. All patients had PTH assay performed at induction of anesthesia and intraoperatively (IOPTH) following thyroid excision. The differences in mean between preoperative vs. intraoperative PTH were assessed using a Wilcoxon rank-sum test. Relationships between PTH and ∆PTH with postoperative calcium levels were assessed using Pearson’s correlation and a binomial regression analysis was also performed.

Results

The cohort comprised 25 female and three male patients. The mean IOPTH level was significantly lower than the preoperative levels (18.6 ± 19.4 vs. 52.11 ± 46.3; two-tailed p <0.0001). The mean postoperative calcium level was significantly lower than the preoperative calcium level (2.22 ± 0.2 mmol/l vs. 2.29 ± 0.16 mmol/l, respectively, p = 0.162). Attempted correlation of IOPTH levels with postoperative calcium yielded a Pearson’s correlation coefficient R of 0.064 (p = 0.748). A weakly negative correlation was found between ∆PTH and postoperative calcium, R = −0.216. Binomial logistic regression analysis was not statistically significant for this cohort (X2 = 10.8; p = 0.216).

Conclusion

We found no association between PTH levels and postoperative calcium levels. ∆PTH may be a superior parameter in predicting postoperative hypocalcemia in total thyroidectomy. Post hoc analysis of existing study databases could further demonstrate the advantage of ∆PTH in risk stratification.

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Authors and Affiliations

  1. Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland

    Cathleen J. O’Neill, M. Jinih, S. Boyle, M. Majeed, A. A. Achakzai & H. P. Redmond

  2. University College Cork, Cork, Ireland

    Cathleen J. O’Neill, M. Jinih & H. P. Redmond

  3. Bon Secours Hospital, Cork, Ireland

    S. A. Brennan

Authors
  1. Cathleen J. O’Neill
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  2. M. Jinih
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  3. S. Boyle
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  4. S. A. Brennan
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  5. M. Majeed
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  6. A. A. Achakzai
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  7. H. P. Redmond
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Corresponding author

Correspondence to Cathleen J. O’Neill.

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Conflict of interest

C. J. O’Neill, M. Jinih, S. Boyle, S.A. Brennan, M. Mudassar, A.A. Achakzai, and H.P. Redmond. declare that they have no competing interests.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (in its most recently amended version). Informed patient consent was not required by the Cork Research Ethics Committee whom granted ethics approval for this study. All data were anonymized and stored on a password-controlled computer with access only to aforenamed authors.

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O’Neill, C.J., Jinih, M., Boyle, S. et al. Risk reduction of hypocalcemia after thyroidectomy. Eur Surg 50, 8–13 (2018). https://doi.org/10.1007/s10353-017-0496-7

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  • DOI: https://doi.org/10.1007/s10353-017-0496-7

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