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VOLUME 12 , ISSUE 2 ( May-August, 2020 ) > List of Articles
Citation Information : Utilizing Immediate Postoperative Serum Parathyroid Hormone in Predicting Severe Hypocalcemia Post-thyroidectomy. World J Endoc Surg 2020; 12 (2):76-79.
License: CC BY-NC 4.0
Published Online: 03-04-2021
Copyright Statement: Copyright © 2020; The Author(s).
Background: Postoperative hypocalcemia is a common complication of thyroid surgery. Serum parathyroid hormone (PTH) levels are a useful adjunct in predicting the likelihood of developing hypocalcemia. This can be used in identifying patients suitable for early discharge. However, there has been no consensus on the ideal timing of postoperative serum PTH. Materials and methods: We retrospectively reviewed 122 patients who underwent completion or total thyroidectomy from January 2013 to October 2017. Patient's preexisting clinical data were collated and analyzed. Results: The incidence of hypoparathyroidism and hypocalcemia was 36% and 48%, respectively, within the entire cohort. A normal serum PTH at skin closure was found to have a negative predictive value (NPV) of 96.5% for hypocalcemia with a sensitivity and specificity of 84.6% and 91.7%. The severity of hypocalcemia was found to be inversely related with the timing of the first dose of calcitriol replacement. Patients were more likely to develop severe hypercalcemia at a rate of 18.2% vs 16.7% vs 53.9% (p = 0.05) depending if they received it within 12 hours, between 12 hours and 24 hours, or after 24 hours from surgery. Conclusion: Serum PTH at skin closure can identify patients who are unlikely to develop severe hypocalcemia. It is also useful to identify patients who will benefit from calcitriol replacement early so as to reduce the severity of hypocalcemia.