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Evidence for the Role of Perioperative PTH Measurement after Total Thyroidectomy as a Predictor of Hypocalcemia

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Abstract

Background

Total thyroidectomy is now accepted worldwide as the standard surgical procedure for the management of benign bilateral nodular thyroid disease. Hypocalcemia is the most common complication of that procedure and a variety of strategies for diagnosing and managing post-thyroidectomy hypocalcemia have been advocated. Increasingly, the use of intact parathyroid hormone (PTH) has been utilized to try to predict those patients at risk of developing post-thyroidectomy hypocalcemia.

Methods

A Medline search of English language literature was performed and we reviewed the evidence in relation to the following three issues: the accuracy of PTH in predicting hypocalcemia, the optimal timing for measuring PTH, and the routine use of oral calcium supplements.

Results

Post-thyroidectomy PTH levels accurately predict hypocalcemia but lack 100% accuracy. Progressive and severe hypocalcemia is unlikely in the setting of a normal PTH level and hence PTH can be cautiously used to facilitate discharge within 24 h for many patients. In addition, PTH levels can be used to implement early treatment with calcium and/or vitamin D supplements to reduce the incidence and severity of hypocalcemia. A single PTH measurement taken any time from 10 min to several hours postoperative will provide equally accurate results for predicting post-thyroidectomy hypocalcemia. Routine use of oral calcium supplements may reduce the incidence and severity of post-thyroidectomy hypocalcemia.

Conclusion

Postoperative PTH can be used to stratify the risk of patients developing hypocalcemia after thyroidectomy. In addition, the routine use of oral calcium supplements can lead to decreased incidence and severity of post-thyroidectomy hypocalcemia. Protocols based on PTH and the routine use of oral calcium supplements can lead to improved patient outcomes after thyroidectomy.

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References

  1. Pattou F, Combemale F, Fabre S et al (1998) Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 22:718–724

    Article  PubMed  CAS  Google Scholar 

  2. Lo Gerfo P, Gates R, Gazetas P (1991) Outpatient and short-stay thyroid surgery. Head Neck 13:97–101

    Article  PubMed  CAS  Google Scholar 

  3. Mowschenson PM, Hodin RA (1995) Outpatient thyroid and parathyroid surgery: a prospective study of feasibility, safety, and costs. Surgery 118:1051–1053; discussion 1053–1054

    Article  PubMed  CAS  Google Scholar 

  4. McHenry CR (1997) “Same-day” thyroid surgery: an analysis of safety, cost savings, and outcome. Am Surg 63:586–589; discussion 589–590

    PubMed  CAS  Google Scholar 

  5. Schwartz AE, Clark OH, Ituarte P et al (1998) Therapeutic controversy: Thyroid surgery—the choice. J Clin Endocrinol Metab 83:1097–1105

    Article  PubMed  CAS  Google Scholar 

  6. Heinrich S, Schafer M, Rousson V et al (2006) Evidence-based treatment of acute pancreatitis: a look at established paradigms. Ann Surg 243:154–168

    Article  PubMed  Google Scholar 

  7. Alia P, Moreno P, Rigo R et al (2007) Postresection parathyroid hormone and parathyroid hormone decline accurately predict hypocalcemia after thyroidectomy. Am J Clin Pathol 127:592–597

    Article  PubMed  CAS  Google Scholar 

  8. Di Fabio F, Casella C, Bugari G et al (2006) Identification of patients at low risk for thyroidectomy-related hypocalcemia by intraoperative quick PTH. World J Surg 30:1428–1433

    Article  PubMed  Google Scholar 

  9. Lo CY, Luk JM, Tam SC (2002) Applicability of intraoperative parathyroid hormone assay during thyroidectomy. Ann Surg 236:564–569

    Article  PubMed  Google Scholar 

  10. Sywak MS, Palazzo FF, Yeh M et al (2007) Parathyroid hormone assay predicts hypocalcaemia after total thyroidectomy. ANZ J Surg 77:667–670

    Article  PubMed  Google Scholar 

  11. Grodski S, Farrell S (2007) Early postoperative PTH levels as a predictor of hypocalcaemia and facilitating safe early discharge after total thyroidectomy. Asian J Surg 30:178–182

    Article  PubMed  Google Scholar 

  12. Khafif A, Pivoarov A, Medina JE et al (2006) Parathyroid hormone: a sensitive predictor of hypocalcemia following total thyroidectomy. Otolaryngol Head Neck Surg 134:907–910

    Article  PubMed  Google Scholar 

  13. Wong C, Price S, Scott-Coombes D (2006) Hypocalcaemia and parathyroid hormone assay following total thyroidectomy: predicting the future. World J Surg 30:825–832

    Article  PubMed  CAS  Google Scholar 

  14. McLeod IK, Arciero C, Noordzij JP et al (2006) The use of rapid parathyroid hormone assay in predicting postoperative hypocalcemia after total or completion thyroidectomy. Thyroid 16:259–265

    Article  Google Scholar 

  15. Ghaheri BA, Liebler SL, Andersen PE et al (2006) Perioperative parathyroid hormone levels in thyroid surgery. Laryngoscope 116:518–521

    Article  PubMed  CAS  Google Scholar 

  16. 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 

  17. Vescan A, Witterick I, Freeman J (2005) Parathyroid hormone as a predictor of hypocalcemia after thyroidectomy. Laryngoscope 115:2105–2108

    Article  PubMed  CAS  Google Scholar 

  18. Soon PS, Magarey CJ, Campbell P et al (2005) Serum intact parathyroid hormone as a predictor of hypocalcaemia after total thyroidectomy. ANZ J Surg 75:977–980

    Article  PubMed  Google Scholar 

  19. Moriyama T, Yamashita H, Noguchi S et al (2005) Intraoperative parathyroid hormone assay in patients with Graves’ disease for prediction of postoperative tetany. World J Surg 29:1282–1287

    Article  PubMed  Google Scholar 

  20. 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  PubMed  CAS  Google Scholar 

  21. Quiros RM, Pesce CE, Wilhelm SM et al (2005) Intraoperative parathyroid hormone levels in thyroid surgery are predictive of postoperative hypoparathyroidism and need for vitamin D supplementation. Am J Surg 189:306–309

    Article  PubMed  CAS  Google Scholar 

  22. Payne RJ, Hier MP, Cote V et al (2005) Postoperative parathyroid hormone levels in conjunction with corrected calcium values as a predictor of post-thyroidectomy hypocalcemia: review of outcomes 1 year after the implementation of a new protocol. J Otolaryngol 34:323–327

    Article  PubMed  Google Scholar 

  23. Payne RJ, Tewfik MA, Hier MP et al (2005) Benefits resulting from 1- and 6-hour parathyroid hormone and calcium levels after thyroidectomy. Otolaryngol Head Neck Surg 133:386–390

    Article  PubMed  Google Scholar 

  24. Payne RJ, Hier MP, Tamilia M et al (2005) Same-day discharge after total thyroidectomy: the value of 6-hour serum parathyroid hormone and calcium levels. Head Neck 27:1–7

    Article  PubMed  Google Scholar 

  25. Del Rio P, Arcuri MF, Ferreri G et al (2005) The utility of serum PTH assessment 24 hours after total thyroidectomy. Otolaryngol Head Neck Surg 132:584–586

    Article  PubMed  Google Scholar 

  26. Warren FM, Andersen PE, Wax MK et al (2004) Perioperative parathyroid hormone levels in thyroid surgery: preliminary report. Laryngoscope 114:689–693

    Article  PubMed  Google Scholar 

  27. Higgins KM, Mandell DL, Govindaraj S et al (2004) The role of intraoperative rapid parathyroid hormone monitoring for predicting thyroidectomy-related hypocalcemia. Arch Otolaryngol Head Neck Surg 130:63–67

    Article  PubMed  Google Scholar 

  28. 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 

  29. Lam A, Kerr PD (2003) Parathyroid hormone: an early predictor of postthyroidectomy hypocalcemia. Laryngoscope 113:2196–2200

    Article  PubMed  CAS  Google Scholar 

  30. Richards ML, Bingener-Casey J, Pierce D et al (2003) Intraoperative parathyroid hormone assay: an accurate predictor of symptomatic hypocalcemia following thyroidectomy. Arch Surg 138:632–635; discussion 635–636

    Article  PubMed  Google Scholar 

  31. Payne RJ, Hier MP, Tamilia M et al (2003) Postoperative parathyroid hormone level as a predictor of post-thyroidectomy hypocalcemia. J Otolaryngol 32:362–367

    Article  PubMed  Google Scholar 

  32. Warren FM, Andersen PE, Wax MK et al (2002) Intraoperative parathyroid hormone levels in thyroid and parathyroid surgery. Laryngoscope 112:1866–1870

    Article  PubMed  CAS  Google Scholar 

  33. Lindblom P, Westerdahl J, Bergenfelz A (2002) Low parathyroid hormone levels after thyroid surgery: a feasible predictor of hypocalcemia. Surgery 131:515–520

    Article  PubMed  Google Scholar 

  34. Australian Endocrine Surgeons (2007) Guidelines AES06/01. Postoperative parathyroid hormone measurement and early discharge after total thyroidectomy: analysis of Australian data and management recommendations. ANZ J Surg 77:199–202

    Article  Google Scholar 

  35. Roh JL, Park CI (2006) Intraoperative parathyroid hormone assay for management of patients undergoing total thyroidectomy. Head Neck 28:990–997

    Article  PubMed  Google Scholar 

  36. 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 

  37. Roh JL, Park CI (2006) Routine oral calcium and vitamin D supplements for prevention of hypocalcemia after total thyroidectomy. Am J Surg 192:675–678

    Article  PubMed  CAS  Google Scholar 

  38. Moore FD Jr (1994) Oral calcium supplements to enhance early hospital discharge after bilateral surgical treatment of the thyroid gland or exploration of the parathyroid glands. J Am Coll Surg 178:11–16

    PubMed  Google Scholar 

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Authors and Affiliations

  1. The Alfred Hospital, Monash University Endocrine Surgery Unit, Melbourne, VIC, 3144, Australia

    Simon Grodski & Jonathan Serpell

  2. Monash University Endocrine Surgery Unit, c/o Suite 56, Cabrini Hospital, 1 Isabella St. Malvern, Melbourne, 3144, Australia

    Simon Grodski

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  1. Simon Grodski
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  2. Jonathan Serpell
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Correspondence to Simon Grodski.

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Grodski, S., Serpell, J. Evidence for the Role of Perioperative PTH Measurement after Total Thyroidectomy as a Predictor of Hypocalcemia. World J Surg 32, 1367–1373 (2008). https://doi.org/10.1007/s00268-008-9545-5

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