Low parathyroid hormone levels after thyroid surgery: a feasible predictor of hypocalcemia.
(2002) In Surgery 131(5). p.515-520- Abstract
- BACKGROUND: Selecting patients with a low risk of hypocalcemia is mandatory if patients are to be discharged on the first day after bilateral thyroidectomy. This study investigated the predictive value of intraoperative parathyroid hormone (PTH). METHODS: Thirty-eight patients underwent total or near-total thyroidectomy. Patients with or without biochemical and symptomatic hypocalcemia were compared regarding intraoperative PTH levels and previously suggested risk factors. The accuracy of intraoperative PTH to predict patients at risk for postoperative hypocalcemia was compared with a calcium concentration of less than 2.00 mmol/L (8.0 mg/dL) on the first postoperative day. RESULTS: PTH levels after resection of the second lobe, age, and... (More)
- BACKGROUND: Selecting patients with a low risk of hypocalcemia is mandatory if patients are to be discharged on the first day after bilateral thyroidectomy. This study investigated the predictive value of intraoperative parathyroid hormone (PTH). METHODS: Thirty-eight patients underwent total or near-total thyroidectomy. Patients with or without biochemical and symptomatic hypocalcemia were compared regarding intraoperative PTH levels and previously suggested risk factors. The accuracy of intraoperative PTH to predict patients at risk for postoperative hypocalcemia was compared with a calcium concentration of less than 2.00 mmol/L (8.0 mg/dL) on the first postoperative day. RESULTS: PTH levels after resection of the second lobe, age, and number of parathyroid glands identified intraoperatively were independently associated with the reduction in serum calcium concentration measured at nadir on the first or second postoperative day. PTH levels after resection of the second lobe were lower among patients who developed biochemical (P <.001) and symptomatic hypocalcemia (P <.01) compared with those who did not. Low levels of intraoperative PTH identified the 3 patients who required intravenous calcium during the first 24 postoperative hours. An intraoperative PTH level below reference range and a calcium concentration of less than 2.00 mmol/L measured 1 day postoperatively both predicted biochemical hypocalcemia with a similar sensitivity (90% vs 90%) and specificity (75% vs 82%). Intraoperative PTH was slightly better than a serum calcium concentration of less than 2.00 mmol/L on postoperative day 1 to predict symptomatic hypocalcemia, with a sensitivity of 71% vs 52% and a specificity of 81% vs 76%, respectively. CONCLUSIONS: Parathyroid gland insufficiency is the main determinant of transient hypocalcemia after bilateral thyroid surgery. Low intraoperative PTH levels during thyroid surgery are therefore a feasible predictor of postoperative hypocalcemia. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/108290
- author
- Lindblom, Pia LU ; Westerdahl, Johan LU and Bergenfelz, Anders LU
- organization
- publishing date
- 2002
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Human, Female, 80 and over, Aged, Adult, Adolescence, Male, Middle Age, Parathyroid Hormones : blood, Postoperative Complications : etiology, Thyroidectomy : adverse effects, Hypocalcemia : diagnosis, Hypocalcemia : etiology, Hypoparathyroidism : complications
- in
- Surgery
- volume
- 131
- issue
- 5
- pages
- 515 - 520
- publisher
- Elsevier
- external identifiers
-
- pmid:12019404
- wos:000175512100008
- scopus:0036247248
- ISSN
- 1532-7361
- DOI
- 10.1067/msy.2002.123005
- language
- English
- LU publication?
- yes
- id
- 344236d5-a864-48e5-b1ee-a0726dd1ae0a (old id 108290)
- alternative location
- http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12019404&dopt=Abstract
- date added to LUP
- 2016-04-01 16:16:41
- date last changed
- 2022-01-28 18:34:01
@article{344236d5-a864-48e5-b1ee-a0726dd1ae0a,
abstract = {{BACKGROUND: Selecting patients with a low risk of hypocalcemia is mandatory if patients are to be discharged on the first day after bilateral thyroidectomy. This study investigated the predictive value of intraoperative parathyroid hormone (PTH). METHODS: Thirty-eight patients underwent total or near-total thyroidectomy. Patients with or without biochemical and symptomatic hypocalcemia were compared regarding intraoperative PTH levels and previously suggested risk factors. The accuracy of intraoperative PTH to predict patients at risk for postoperative hypocalcemia was compared with a calcium concentration of less than 2.00 mmol/L (8.0 mg/dL) on the first postoperative day. RESULTS: PTH levels after resection of the second lobe, age, and number of parathyroid glands identified intraoperatively were independently associated with the reduction in serum calcium concentration measured at nadir on the first or second postoperative day. PTH levels after resection of the second lobe were lower among patients who developed biochemical (P <.001) and symptomatic hypocalcemia (P <.01) compared with those who did not. Low levels of intraoperative PTH identified the 3 patients who required intravenous calcium during the first 24 postoperative hours. An intraoperative PTH level below reference range and a calcium concentration of less than 2.00 mmol/L measured 1 day postoperatively both predicted biochemical hypocalcemia with a similar sensitivity (90% vs 90%) and specificity (75% vs 82%). Intraoperative PTH was slightly better than a serum calcium concentration of less than 2.00 mmol/L on postoperative day 1 to predict symptomatic hypocalcemia, with a sensitivity of 71% vs 52% and a specificity of 81% vs 76%, respectively. CONCLUSIONS: Parathyroid gland insufficiency is the main determinant of transient hypocalcemia after bilateral thyroid surgery. Low intraoperative PTH levels during thyroid surgery are therefore a feasible predictor of postoperative hypocalcemia.}},
author = {{Lindblom, Pia and Westerdahl, Johan and Bergenfelz, Anders}},
issn = {{1532-7361}},
keywords = {{Human; Female; 80 and over; Aged; Adult; Adolescence; Male; Middle Age; Parathyroid Hormones : blood; Postoperative Complications : etiology; Thyroidectomy : adverse effects; Hypocalcemia : diagnosis; Hypocalcemia : etiology; Hypoparathyroidism : complications}},
language = {{eng}},
number = {{5}},
pages = {{515--520}},
publisher = {{Elsevier}},
series = {{Surgery}},
title = {{Low parathyroid hormone levels after thyroid surgery: a feasible predictor of hypocalcemia.}},
url = {{http://dx.doi.org/10.1067/msy.2002.123005}},
doi = {{10.1067/msy.2002.123005}},
volume = {{131}},
year = {{2002}},
}