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2009 | 81 | 8 | 340-347
Article title

Intraoperative Parathyroid Hormone Level as a Predictor of Post-Thyroidectomy Hyproparathyrodism

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EN
Abstracts
EN
Hypoparathyroidism is the most common complication of thyroid surgery. Accurate treatment of this condition requires early diagnosis of patients at risk of hypocalcemia.The aim of the study was to evaluate the predictive value of intraoperative parathyroid hormone assessment in identification of affected subjects.Material and methods. Sixty five subjects participated in the prospective study. They underwent bilateral neck exploration with subtotal or total thyroidectomy. Parathormone (PTH) and calcium levels were assessed prior to surgery, intraoperatively and at different time-points following the operation.Results. In respect of the results, patients were allocated into 3 groups: (A) subjects with asymptomatic course; (B) subjects with perioperative symptomatic hypocalcemia; (C) subjects with prolonged symptomatic hypocalcemia. No differences between these groups were observed in the intraoperative calcium levels. Intraoperative parathormone (ioPTH) level was significantly lower in group C and at value minor of the reference range identified group C subjects with sensitivity and specificity of 100 and 91.5%, respectively. Mean intraoperative PTH level decrease (ΔioPTH) of 22.5% was observed. ΔioPTH rate was significantly higher (81.4%) in group C. This parameter presented sensitivity of 66.7% and specificity of 93.2% in identification of group C patients.Conclusions. Single intraoperative PTH level assessment identifies subjects at risk of postoperative hypoparathyroidism. Intraoperative drop of PTH (ΔioPTH) proves less sensitive. Intraoperative calcium levels cannot be regarded as a predictor of this complication.
Publisher

Year
Volume
81
Issue
8
Pages
340-347
Physical description
Dates
published
1 - 8 - 2009
online
22 - 10 - 2010
Contributors
  • Department of Endocrine and General Surgery, Medical University in Łódź
  • Department of Endocrine and General Surgery, Medical University in Łódź
  • Department of Experimental Surgery, Chair of Endocrinology, Medical University in Łódź
References
  • Dralle H: Impact of modern technologies on quality of thyroid surgery (editorial). Langenbeck's Arch Surg 2006; 391(1): 1-3.
  • Rosato L, Avenia N, Bernante P et al.: Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated in Italy over 5 years. World J Surg 2004; 28: 271-76.
  • Cichoń W, Konturek A, Anielski R i wsp.: Hipokalcemia po operacji tarczycy. Doświadczenia własne na podstawie materiału 987 chorych operowanych z powodu różnych schorzeń tarczycy w czasie roku. Pol Przegl Chir 2007; 79: 860-70.
  • Kim OJ: William Stewart Halsted in the history of American Surgery. Kor J Med Hist 2003; 12: 66-87.
  • Lo CY, Tam SC: Parathyroid autotransplantation during thyoridectomy. Documentation of graft function. Arch Surg 2001; 136: 1381-85.
  • Lindblom P, Westerdahl J, Bergenfelz A: Low parathyroid hormone levels after thyroid surgery: A feasible predictor of hypocalcemia. Surg 2002; 131(5): 515-20.
  • Di Fabio F, Casella C, Bugari G et al.: Identification of patients at low risk for thyroidectomy-related hypocalcemia by intraoperative quick PTH. World J Surg 2006; 30: 1428-33.
  • McHenry CR, Speroff T, Wentworth D et al.: Risk factors for postthyroidectomy hypocalcemia. Surg 1994; 116: 641-48.
  • Wong C, Price S, Scott-Coombes D: Hypocalcaemia and parath-32.
  • Lo CY, Luk JM, Tam SC: Applicability of intraoperative parathyroid hormone assay during thyroidectomy. Ann Surg 2002; 236(5): 564-69.
  • Lepage R, Legare G, Racicot C et al.: Hypocalcemia induced during major and minor abdominal surgery in humans. J Clin Endocrin Metab 1999; 84: 2654-58.
  • Pattou F, Combemale F, Fabre S et al.: Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 1998; 22: 718-24.
  • Hermann M, Ott J, Promberger R et al.: Kinetics of serum parathyroid hormone during and after thyroid surgery. Br J Surg 2008; 95:1480-87.
  • Cahill RA, Harty R, Cotter S et al.: Parathormone response to thyroid surgery. Am J Surg 2006; 191: 453-59.
  • Barczyński M, Cichoń S, Kontuerk A: Przydatność śródoperacyjnego oznaczania parathormonu we wtórnej nerkopochodnej nadczynności przytarczyc - obserwacje wstępne. Pol Przegl Chir 2003; 75: 966-82.
  • Warren FM, Andersen PE, Wax MK et al.: Intraoperative parathyroid hormone levels in thyroid and parathyroid surgery. Laryngoscope 2002; 112: 1866-70.
  • Payne RJ, Tewfik MA, Hier MP et al.: Benefits resulting from 1- and 6-hour parathyroid hormone and calcium levels after thyroidectomy. Otol Head Neck Surg 2005; 133: 386-90.
  • Higgins KM, Mandell DL, Govindaraj S et al.: The role of intraoperative rapid parathyroid hormone monitoring for predicting thyroidectomy-realted hypocalcemia. Arch Otol Head Neck Surg 2004; 130: 63-67.
  • Lam A, Kerr PD: Parathyroid hormone: an early predictor of postthyroidectomy hypocalcemia. Laryngoscope 2003; 113: 2196-200.
  • Warren FM, Andersen PE, Wax MK et al.: Perioperative parathyroid hormone levels in thyroid surgery: Preliminary report. Laryngoscope 2004; 114: 689-93.
  • Richards ML, Bingener-Casey J, Pierce D et al.: Intraoperative parathyroid hormone assay: An accurate predictor of symptomatic hypocalcemia following thyroidectomy. Arch Surg 2003; 138: 632-36.
  • Cooper Scurry Jr W, Beus KS, Hollenbeak CS et al.: Perioperative parathyroid hormonr assay for diagnosis and management of postthyroidectomy hypocalcemia. Laryngoscope 2005; 115: 1362-66.
  • Feldman AL, Sharaf RN, Scarulis MC et al.: Results of heterotopic parathyroid autotransplantation: A 13-year experience. Surg 1999; 126: 1042-48.
  • Kikumori T, Imai T, Tanaka Y et al.: Parathyroid autotransplantation with total thyroidectomy for thyroid carcinoma: Long-term follow up of grafted parathyroid function. Surg 1999; 125: 504-08.
  • Zedenius J, Wadstrom C, Delbridge L: Routine autotransplantation of at least one parathyroid gland during total thyroidectomy may reduce permanent hypoparathyroidism to zero. ANZ J Surg 1999; 69: 794-97.
  • Gauger PG, Reeve TS, Wilkinson M et al.: Routine parathyroid autotransplantation during total thyroidectomy: the influence of technique. Eur J Surg 2000; 166: 605-09.
Document Type
Publication order reference
Identifiers
YADDA identifier
bwmeta1.element.-psjd-doi-10_2478_v10035-009-0057-2
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