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Early Prediction of Hypocalcemia after Thyroidectomy using Parathyroid Hormone: An Analysis of Pooled Individual Patient Data from Nine Observational Studies
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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“Low iPTH levels (<10-15 pg/mL) in the immediate postoperative setting appear to predict symptomatic hypocalcemia and need for calcium and calcitriol (1,25 vitamin D) supplementation (212,213).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [212]
Citations
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“Low iPTH levels (<10–15 pg/mL) in the immediate postoperative setting appear to predict symptomatic hypocalcemia and need for calcium and calcitriol (1,25 vitamin D) supplementation (212,213).”
BackgroundBahn, R. S., Burch, H. B., Cooper, D. S., Garber, J. R., Greenlee, M. C., Klein, I., Laurberg, P., McDougall, I. R., Montori, V. M., Rivkees, S. A., et al. (2011) · Endocrine Practice · doi:10.4158/ep.17.3.456 · Cited by 1,098
The American Thyroid Association and American Association of Clinical Endocrinologists Taskforce on Hyperthyroidism and Other Causes of Thyrotoxicosis, Bahn, R. S., Burch, H. B., Cooper, D. S., Garber, J. R., Greenlee, M. C., Klein, I., Laurberg, P., McDougall, I. R., Montori, V. M., et al. (2011) · Thyroid · doi:10.1089/thy.2010.0417 · Cited by 898
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Self-citationComplications after total thyroidectomy
Christou, N., & Mathonnet, M. (2013) · Journal of Visceral Surgery · doi:10.1016/j.jviscsurg.2013.04.003 · Cited by 309
Metadata
- 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
- Venue
- Journal of the American College of Surgeons
- Published
- 2007-12
- Volume
- 205
- Issue
- 6
- Pages
- 748-754
- ISSN
- 1072-7515 (ISSN-L)
- 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
- 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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