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The timing of parathyroid hormone measurement defines the cut-off values to accurately predict postoperative hypocalcemia: a prospective study

Abstract

Purpose

Serum intact parathyroid hormone (iPTH) level is an early marker of post-thyroidectomy hypocalcemia. However, lack of methodological standardization to define timing and cut-off points of iPTH measurement limit its clinical applicability. Here, we evaluated the relationship between two distinct postoperative time sampling and iPTH accuracy on predicting hypocalcemia.

Methods

iPTH was measured within 4 h after surgery (iPTH 4 h) and on the morning of the first postoperative day (iPTH 1st PO). Hypocalcemia was defined by levels of total calcium corrected by serum albumin ≤ 8.0 mg/dL and/or by the presence of symptoms. The most accurate iPTH cut-off point for hypocalcemia prediction was established from a ROC curve comparing both time-points.

Results

The study included 101 patients. The mean age was 52.4 ± 12.9 years, 93 were women (92.1%) and 69 patients underwent total thyroidectomy (68.3%). Hypocalcemia occurred in 25 patients (24.8%), of whom 12 were symptomatic. Total thyroidectomy, longer duration of surgery, surgical complications related to parathyroid glands and lower levels of iPTH 4 h and iPTH 1st PO were associated with postoperative hypocalcaemia (all P < 0.05). Using the ROC curve, the optimal cut-off points were 19.55 pg/mL and 14.35 pg/mL for iPTH 4 h and iPTH 1st PO, respectively. The comparison of the AUC showed no significant difference between these two points of evaluation (0.935 vs. 0.940; P = 0.415).

Conclusions

Serum iPTH levels measured within 4 h or on the first morning after surgery are predictors of postoperative hypocalcemia. Notably, both time-points have the same accuracy to predict postoperative hypocalcemia (with different cutoff points).

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Acknowledgements

This work has been made possible by grants from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Fundo de Incentivo a Pesquisa (FIPE) and Programa de Apoio a Núcleos de Excelência (PRONEX) / Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS). We wish to thank the surgeons of our Hospital, Dr. Alceu Migliavacca, Dr. José Ricardo Guimarães, and Dr. Diego Mossmann, for surgical management of our patients.

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Correspondence to Ana Luiza Maia.

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Filho, E.B.Y., Machry, R.V., Mesquita, R. et al. The timing of parathyroid hormone measurement defines the cut-off values to accurately predict postoperative hypocalcemia: a prospective study. Endocrine 61, 224–231 (2018). https://doi.org/10.1007/s12020-018-1601-9

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  • DOI: https://doi.org/10.1007/s12020-018-1601-9

Keywords

  • Hypoparathyroidism
  • Thyroidectomy
  • Hypocalcemia
  • Parathyroid hormone