Cited by 192Thyroid and Parathyroid SurgeryParathyroid Disorders and TreatmentsThyroid Disorders and Treatments

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Early Prediction of Hypocalcemia after Thyroidectomy using Parathyroid Hormone: An Analysis of Pooled Individual Patient Data from Nine Observational Studies

Noordzij, Pieter J., Lee, Stephanie L., Bernet, Victor J., Payne, Richard J., Cohen, Seth M., McLeod, Ian K., Hier, Michael P., Black, Martin J., Kerr, Paul D., Richards, Melanie L., Lo, Chung Yau, Raffaelli, Marco, Bellantone, Rocco, Lombardi, Celestino P., Cohen, James I., Dietrich, Mary S.·2007·Journal of the American College of Surgeons

DOI 10.1016/j.jamcollsurg.2007.06.298

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Abstract

BACKGROUND: Monitoring for hypocalcemia after thyroidectomy, using only symptoms and serum calcium levels, can delay the discharge of patients who will remain normocalcemic and can delay the treatment of hypocalcemic patients. STUDY DESIGN: We conducted a systematic search for articles describing use of parathyroid hormone (PTH) assay, checked within hours of completing thyroidectomy, to predict postoperative symptomatic hypocalcemia. Studies were excluded if all patients were treated with postoperative calcium, or if early PTH values were used to alter management of the patient. Individual patient data (perioperative PTH and calcium levels, development of hypocalcemia) were obtained for 457 patients from the corresponding authors of 9 studies and pooled to yield the following results. RESULTS: PTH, checked at three time periods after removal of the thyroid gland (0 to 20 minutes, 1 to 2 hours, and 6 hours), was substantially lower in patients who became hypocalcemic compared with those who remained normocalcemic. The accuracy of PTH in determining hypocalcemia increased with time and was excellent when checked 1 to 6 hours postoperatively. A single PTH threshold (65% decrease compared with preoperative level), checked 6 hours after completing thyroidectomy, had a sensitivity of 96.4% and specificity of 91.4% in detecting postoperative hypocalcemia. CONCLUSIONS: PTH assay, when checked 1 to 6 hours after thyroidectomy, has excellent accuracy in determining which patients will become symptomatically hypocalcemic. Routine use of this assay should be considered because it may allow earlier discharge of the normocalcemic patient and earlier identification of patients requiring treatment of postthyroidectomy hypocalcemia.

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Authors: Noordzij, P. J., Lee, S. L., Bernet, V. J., Payne, R. J., Cohen, S. M., McLeod, I. K., Hier, M. P., Black, M. J., Kerr, P. D., Richards, M. L., Lo, C. Y., Raffaelli, M., Bellantone, R., Lombardi, C. P., Cohen, J. I., & Dietrich, M. S.
Affiliations: Boston University (US)
Walter Reed National Military Medical Center (US)
Jewish General Hospital (CA)
Duke University (US)
University of Manitoba (CA)
Mayo Clinic (US)
Queen Mary Hospital (CN)
Università Cattolica del Sacro Cuore (IT)
Oregon Health & Science University (US)
Vanderbilt University (US)
ORCID: Lee, Stephanie L.
Bernet, Victor J.
Payne, Richard J.
Cohen, Seth M.
Hier, Michael P.
Raffaelli, Marco
Bellantone, Rocco
Cohen, James I.
Dietrich, Mary S.
Venue: Journal of the American College of Surgeons
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2007-12
Volume: 205
Issue: 6
Pages: 748-754
ISSN: 1072-7515 (ISSN-L)
DOI: 10.1016/j.jamcollsurg.2007.06.298
OpenAlex: W2043355472
Cited by: 192
References: 30
Citations by year: 2026: 8 · 2025: 3 · 2024: 6 · 2023: 3 · 2022: 6 · 2021: 13 · 2020: 10 · 2019: 12 · 2018: 8 · 2017: 19 · 2016: 8 · 2015: 21 · 2014: 12 · 2013: 13 · 2012: 12
FWCI: 7.96
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of the American College of Surgeons (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Keywords: postoperative hypocalcemia, thyroidectomy, parathyroid hormone assay, postoperative discharge, diagnostic accuracy, sensitivity and specificity
MeSH terms: Humans, Hypocalcemia, Parathyroid Hormone, Predictive Value of Tests, ROC Curve, Thyroidectomy, Time Factors

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Early Prediction of Hypocalcemia after Thyroidectomy using Parathyroid Hormone: An Analysis of Pooled Individual Patient Data from Nine Observational Studies

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