PARATHYROID HORMONE ASSAY PREDICTS HYPOCALCAEMIA AFTER TOTAL THYROIDECTOMY
Abstract
Background: Postoperative parathyroid gland function after total thyroidectomy (TT) has traditionally been monitored by the measurement of serum calcium concentrations. The purpose of this study is to determine whether measurement of parathyroid hormone (PTH) concentrations in the early postoperative period accurately predicts patients at risk of developing hypocalcaemia. Methods: A prospective cohort study of patients undergoing TT was carried out. PTH concentrations were measured preoperatively and at 4 and 23 h postoperatively. Serum calcium concentration was measured preoperatively and twice daily for 48 h after surgery. Results: One hundred patients undergoing TT were recruited into the study in the period June 2004 to July 2005. Benign multinodular goitre was the most common indication for surgery (77%). The incidence of temporary hypocalcaemia (Ca < 2.0 mmol/L) was 18%. The mean PTH concentration at 4 h after surgery was 22.3 ng/L and was not significantly different from the 23‐h concentration of 23.2 ng/L ( P = 0.18). A PTH concentration of ≤3 ng/L measured at 4 h after surgery had a sensitivity, specificity and likelihood ratio of 0.71, 0.94 and 11.3, respectively, for predicting postoperative hypocalcaemia. The accuracy of a single PTH concentration at 4 h was good for predicting hypocalcaemia (area under receiver–operator characteristic curve 0.90; confidence interval 0.81–0.96). There was no significant difference in accuracy between the 4‐ and 24‐h PTH concentrations ( P = 0.14). Conclusions: A single measurement of PTH concentration in the early postoperative period after TT reliably predicts patients who are likely to develop hypocalcaemia. This approach facilitates early discharge and may decrease the need for multiple postoperative blood tests.
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Successful prediction of calcium status after total thyroidectomy can be achieved using the slope of 6- and 12-hour postoperative calcium levels.
“Successful prediction of calcium status after total thyroidectomy can be achieved using the slope of 6-and 12-hour postoperative calcium levels (204-210).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [205]
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- Authors
- Sywak, M. S., Palazzo, F. F., Yeh, M., Wilkinson, M., Snook, K., Sidhu, S. B., & Delbridge, L. W.
- Affiliations
- The University of Sydney (AU)
- Corresponding author
- Sywak, Mark S.
- Venue
- ANZ Journal of Surgery
- Publisher
- Wiley
- Published
- 2007-07-17
- Volume
- 77
- Issue
- 8
- Pages
- 667-670
- ISSN
- 1445-1433 (ISSN-L)
- 1445-2197
- OpenAlex
- W2031944593
- Cited by
- 126
- References
- 14
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 7 · 2023: 6 · 2022: 8 · 2021: 7 · 2020: 10 · 2019: 6 · 2018: 5 · 2017: 12 · 2016: 3 · 2015: 9 · 2014: 9 · 2013: 9 · 2012: 5
- FWCI
- 5.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- ANZ Journal of Surgery (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
- parathyroid hormone, hypocalcemia, total thyroidectomy, postoperative hypoparathyroidism, serum calcium, multinodular goiter, early postoperative monitoring, parathyroid function
- MeSH terms
- Adult, Calcium, Female, Goiter, Nodular, Humans, Hypocalcemia, Male, Middle Aged, Parathyroid Hormone, Postoperative Complications, Sensitivity and Specificity, Thyroidectomy, Likelihood Functions
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