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Low parathyroid hormone levels after thyroid surgery: a feasible predictor of hypocalcemia.

Lindblom, Pia LU ; Westerdahl, Johan LU and Bergenfelz, Anders LU (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)
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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
2007-07-20 11:24:10
date last changed
2017-12-17 03:54:42
@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 &lt;.001) and symptomatic hypocalcemia (P &lt;.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},
  keyword      = {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},
  volume       = {131},
  year         = {2002},
}