Postoperative PTH Measurement as a Predictor of Hypocalcaemia After Thyroidectomy

• Authors: Monika Proczko-Markuszewska , Jarosław Kobiela , Tomasz Stefaniak , Andrzej Łachiński , Zbigniew Śledziński
• Languages of publication: EN

Abstracts

EN

Hypocalcemia after thyroidectomy is the most common postoperative complication with reported incidence from 0.5% to even half of the operated patients. Hypoparathyroidism could be a result of careless or inadequate preparation during the surgical procedure. There is a variety of proposed options for prediction of the incidence of hypocalcemia. The most effective of them are the perioperative and intraoperative measurements of PTH level.The aim of the study was to assess the potential correlation between the iPTH levels after the operation and development of hypocalcaemia. The possible prediction value of postoperative iPTH levels was to be evaluated assessed.Material and methods. A prospective study was performed on 100 patients who underwent total thyroidectomy from January 2007 to June 2009. The total calcium level and intact human PTH (iPTH) levels were measured 24 hours before, 1 and 24 hours after the surgery.Results. We have presented a significant correlation between early iPTH measurement and risk of hypocalcaemia. Moreover a significant correlation between the iPTH level 1 hour after operation with the calcium level 24 hours after the operation was demonstrated.Conclusions. Early postoperative assessment of iPTH levels can be used to identify the group of patients at risk of hypocalcaemia after thyroidectomy. Pre-emptive calcium supplementation can lead to avoidance of complications causing prolonged hospital stay and most importantly to prevent severe hypocalcemia.

Keywords

EN

hypocalcaemia; postoperative parathyroid hormone measurement; thyroidectomy; calcium supplementation

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2010
• Volume: 82
• Issue: 1
• Pages: 24-28

Dates

published

1 - 1 - 2010

online

10 - 2 - 2010

Contributors

author

Monika Proczko-Markuszewska

• Department of General, Endocrine and Transplant Surgery, Medical University, Gdańsk

author

Jarosław Kobiela

• Department of General, Endocrine and Transplant Surgery, Medical University, Gdańsk

author

Tomasz Stefaniak

• Department of General, Endocrine and Transplant Surgery, Medical University, Gdańsk

author

Andrzej Łachiński

• Department of General, Endocrine and Transplant Surgery, Medical University, Gdańsk

author

Zbigniew Śledziński

• Department of General, Endocrine and Transplant Surgery, Medical University, Gdańsk

References

• Schwartz AE, Clark OH, Ituarte P et al.: Therapeutic controversy: Thyroid surgery - the choice. J Clin Endocrinol Metab 1998; 83:1097-1105.
• Lo Gerfo P, Gates R, Gazetas P: Outpatients and short-stay thyroid surgery. Head Neck 1991; 13:97-101.
• McHenry CR: "Same-day" thyroid surgery: an analysis of safety, cost savings, and outcome. Am Surg 1997; 63: 586-89; discussion 589-90.
• Thomusch O, Machens A, Sekulla C et al.: Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 2000; 24: 1335-41.
• Hermann M, Alk G, Roka R et al.: Laryngeal recurrent nerve injury in surgery for benign thyroid dissection and impact of individual surgeon in more than 27,000 nerves at risk. Ann Surg 2002; 235: 261-68.
• Hermann M, Freissmuth M: Neuromonitoring of the recurrent nerve - validation and merits. Eur Surg 2003; 240: 9-17.
• Higgins KM, Mandell DL, Govindaraj S et al.: The role of intraoperative rapid parathyroid hormone monitoring for predicting thyroidectomy - related hypocalcemia. Arch Otolaryngol Head Neck Surg 2004; 130: 63-67.
• Barczyński M, Cichoń S, Konturek A et al.: Applicabillity of intraoperative parathyroid hormone assai during total thyroidectomy as a guide for the surgeon to selective parathyroid tissue autotransplantation. World J Surg 2008; 32: 822-28.[WoS]
• Thomusch O, Machens A, Sekulla C et al.: The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery 2003; 133: 180-85.
• Pisanu A, Piu S, Cois A et al.: Hypocalcemiafollowing total thyroidectomy: early factors predicting long-term outcome. G Chir 2005; 26: 131-34.
• Glinoer D, Andry G, Chantrain G et al.: Clinical aspects of early and late hypocalcemia after thyroid. Eur J Surg Oncol 2000; 26: 571-77.
• Bentrem DJ, Rademaker A, Angelos P: Evaluation of serum calcium levels in predicting hypoparathyroidism after total/near-total thyroidectomy or parathyroidectomy. Am Surg 2001; 67:249-51.
• Falk SA, Birkem EA, Baran DT: Temporary postthyroidectomy hypocalcemia. Arch Otolaryngol Head Neck Surg 1988; 114: 168-74.
• Luu Q, Andresen PE, Adams J et al. The predictive value of perioperative calcium levels after thyroid/parathyroid surgery. Haed Neck 2002; 24: 63-67.
• Moore C, Lampe H, Agrawal S: Predictability of hypocalcemia using early postoperative serum calcium levels. J Otolaryngol 2001; 30: 266-70.
• Richards ML, Bingener-Casey J, Pierce D et al.: Intraoperative parathyroid hormone: an accurate predictor of symptomatic hypocalcemia following thyroidectomy. Arch Surg 2003; 138: 632-35.
• Roh JL, Park JY, Park CI: Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differantiated papillary thyroid carcionoma undergoing thyroidecotmy plus central neck dissection. 2009; 115(2): 251-58.
• Abboud B, Sieilaty G, Zeineddine S et al.: Is therapy with calcium and vitamin D and parathyroid autotransplantation useful in total thyroidectomy for preventing hypocalcemia? Head Neck 2008; 30(9): 1148-54.[WoS][Crossref]
• Payne RJ, Hier MP, Tamilia M et al.: Postoperative parathyroid hormone level as a predictor of post-thyroidectomy hypocalcemia. J Otolaryngol 2003; 32: 362-67.
• Sywak MS, Palazzo FF, Yeh M et al.: Parathyroid hormone assay predicts hypocalcemia after total thyroidectomy. ANZ J Surg 2007; 77: 667-70.[WoS]
• Roh JL, Park CI: Intraoperative parathyroid hormone assayfor managment of patients undergoing total thyroidectomy. Head and Neck 2006; 28: 990-97.
• Ghaheri BA, Liebler SL, Andersen PE et al.: Perioperative parathyroid hormone levels in thyroid surgery. Laryngoscope 2006; 116: 518-21.
• Vescan A, Witterick I, Freeman J: Parathyroid hormone as a predictor of hypocalcemia after thyroidectomy. Laryngoscope 2005; 115: 2105-08.
• Lombardi CP, Raffaelli M, Princi P et al.: Parathyroid hormone levels 4 hours after surgery do not accurately predictmpost-thyroidectomy hypocalcemia. Surgery 2006; 140: 1016-23; disscusion 1023-25.[WoS]
• Australian Endocrine Surgeons Guidelines AES06/01. Postoperative parathyroid measurement and early discharge after total thyroidectomy: analysis of Australian data and management recommendations. ANZ J Surg 2007; 77: 199-202.
• Del Rio P, Arcuri MF, Ferreri G et al.: The utillity of serum PTH assessment 24 hours after thyroidectomy. Otolaryngol Haed Neck Surg 2005; 132: 584-86.
• Alia P, Moreno P, Rigo R et al.: Postresection parathyroid hormone and parathyroid hormone decline accurately predict hypocalcemia after thyroidectomy. Am J Clin Pathol 2007; 127: 592-97.[WoS]

Identifiers

DOI

10.2478/v10035-010-0005-1