Abstract
Postoperative hypocalcemia is a common complication of total thyroidectomy; the onset and severity of post-operative hypocalcemia is unpredictable. Various attempts have been made to identify predictors of hypocalcemia. There has been an increasing interest in serum levels of parathyroid hormone (PTH) as an early predictor of the development of hypocalcemia after total thyroidectomy. However, there is no consensus on the time intervals and cut-off levels of serum PTH to predict hypocalcemia. In this study, we intend to use serum PTH levels at 4th and 12th hour after total thyroidectomy to identify patients at risk of developing Postoperative hypocalcemia and to evaluate the role of PTH in predicting hypocalcemia. A Cross sectional analytical study conducted in 33 patients undergoing total/completion thyroidectomy from December 2018 to May 2020. Serum total calcium, Serum ionized calcium and Serum intact PTH levels were measured on three occasions (Preoperative and 4th and 12th hour Postoperative). Between both Postoperative levels of PTH, the one with better predictability of hypocalcemia was determined. Postoperative 4th hour PTH is a better predictor of transient hypocalcemia than Postoperative 12th hour PTH, as the association of the former with serum ionized calcium level was statistically highly significant with p value 0.005 and 0.021 respectively. Serum PTH determination after four hours of total thyroidectomy is a relatively better predictor of transient hypocalcemia, and can guide calcium supplementation for those at high risk in the Postoperative period. However, to determine the risk of hypocalcemia at the end of 1 month of follow-up, both the Postoperative 4th and post-operative 12th hour PTH have similar diagnostic accuracy.
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References
Carr AA, Yen TW, Fareau GG, Cayo AK, Misustin SM, Evans DB, Wang TS (2014) A single parathyroid hormone level obtained 4 hours after total thyroidectomy predicts the need for postoperative calcium supplementation. J Am Coll Surg 219(4):757–764
Le TN, Kerr PD, Sutherland DE, Lambert P (2014) Validation of 1-hour post-thyroidectomy parathyroid hormone level in predicting hypocalcemia. J otolaryngol Head Neck Surg 43:5. https://doi.org/10.1186/1916-0216-43-5
Saba A, Podda M, Campanella AM, Pisanu A (2017) Early prediction of hypocalcemia following thyroid surgery. A prospective randomized clinical trial. Langenbeck’s Arch Surg 402:1119–1125. https://doi.org/10.1007/s00423-017-1586-5
Toffaletti JG (2011) Is ionized calcium always right and total calcium always wrong. CLN 37(9):8–10
Karatzanis AD, Ierodiakonou DP, Fountakis ES, Velegrakis SG, Doulaptsi MV, Prokopakis EP, Daraki VN, Velegrakis GA (2018) Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy. Head Neck 40(5):1040–1045
Armitage EK (1986) Parathyrin (parathyroid hormone): metabolism and methods for assay. Clin Chem 32(3):418–424
AlQahtani A, Parsyan A, Payne R, Tabah R (2014) Parathyroid hormone levels 1 hour after thyroidectomy: an early predictor of postoperative hypocalcemia. Can J Surg 57(4):237–240. https://doi.org/10.1503/cjs.008013
Reeve T, Thompson NW (2000) Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg 24(8):971–975. https://doi.org/10.1007/s002680010160
Lindblom P, Westerdahl J, Bergenfelz A (2002) Low parathyroid hormone levels after thyroid surgery: a feasible predictor of hypocalcemia. Surgery 131(5):515–520. https://doi.org/10.1067/msy.2002.123005
Rao TU (2016) An early predictor of postoperative hypocalcemia: parathyroid hormone levels 1 hour after thyroidectomy. International Surgery Journal 4(1):233–236
Mazotas IG, Wang TS (2017) The role and timing of parathyroid hormone determination after total thyroidectomy. Gland Surg 6(Suppl 1):38–48. https://doi.org/10.21037/gs.2017.09.06
Del Rio P, Rossini M, Montana CM, Viani L, Pedrazzi G, Loderer T, Cozzani F (2019) Postoperative hypocalcemia: analysis of factors influencing early hypocalcemia development following thyroid surgery. BMC Surg 18(1):25. https://doi.org/10.1186/s12893-019-0483-y
Vanderlei FA, Vieira JG, Hojaij FC, Cervantes O, Kunii IS, Ohe MN, Santos RO, Abrahão M (2012) Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy. Arq Bras Endocrinol Metabol 56:168–172
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Institutional Ethical Committee approval was obtained for: The start of study (IEC No: SDUMC/KLR/IEC/169/2018-19) and, Publication (IEC No: DMC/KLR/IEC/758/2020-21).
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Thakur, K., Susanna, T.Y., Sagayaraj, A. et al. Postoperative Serum Parathyroid Hormone Levels as a Predictor of Hypocalcemia in Patients Undergoing Total Thyroidectomy. Indian J Otolaryngol Head Neck Surg 75, 255–260 (2023). https://doi.org/10.1007/s12070-022-03172-4
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DOI: https://doi.org/10.1007/s12070-022-03172-4