Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-26T14:04:03.745Z Has data issue: false hasContentIssue false
  • English
  • Français

Hypocalcaemia following total thyroidectomy: early post-operative parathyroid hormone assay as a risk stratification and management tool

Published online by Cambridge University Press:  24 March 2014

S Islam ,
T Al Maqbali ,
D Howe  and
J Campbell
S Islam*
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Birmingham Heartlands Hospital, UK
T Al Maqbali
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Birmingham Heartlands Hospital, UK
D Howe
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Birmingham Heartlands Hospital, UK
J Campbell
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Birmingham Heartlands Hospital, UK
*
Address for correspondence: Mr Shofiq Islam, Department of Otolaryngology and Head and Neck Surgery, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To develop a practical, efficient and predictive algorithm to manage potential or actual post-operative hypocalcaemia after complete thyroidectomy, using a single post-operative parathyroid hormone assay.

Methods:

This paper reports a prospective study of 59 patients who underwent total or completion thyroidectomy over a period of 24 months. Parathyroid hormone levels were checked post-operatively on the day of surgery, and all patients were evaluated for hypocalcaemia both clinically and biochemically with serial corrected calcium measurements.

Results:

No patient with an early post-operative parathyroid hormone level of 23 ng/l or more (i.e. approximately twice the lower limit of the normal range) developed hypocalcaemia. All the patients who initially had post-operative hypocalcaemia but had an early parathyroid hormone level of 8 ng/l or more (i.e. approximately two-thirds of the lower limit of the normal range) had complete resolution of their hypocalcaemia within three months.

Conclusion:

Early post-operative parathyroid hormone measurement can reliably predict patients at risk of post-thyroidectomy hypocalcaemia, and predict those patients expected to recover from temporary hypocalcaemia. A suggested post-operative management algorithm is presented.

Keywords

ThyroidectomyHypocalcemiaHypoparathyroidismParathyroid HormonePostoperative CareRisk Factors
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 3 , March 2014 , pp. 274 - 278
Copyright
Copyright © JLO (1984) Limited 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Karamanakos, SN, Markou, KB, Panagopoulos, K, Karavias, D, Vagianos, CE, Scopa, CD et al. Complications and risk factors related to the extent of surgery in thyroidectomy. Results from 2,043 procedures. Hormones 2010;9:318–25CrossRefGoogle Scholar
2Adams, J, Andersen, P, Everts, E, Cohen, J. Early postoperative calcium levels as predictors of hypocalcaemia. Laryngoscope 1998;108:1829–31Google Scholar
3Bieglmayer, C, Prager, G, Niederle, B. Kinetic analyses of parathyroid hormone clearance as measured by three rapid immunoassays during parathyroidectomy. Clin Chem 2002;48:1731–8CrossRefGoogle ScholarPubMed
4Husein, M, Hier, MP, Al-Abdulhadi, K, Black, M. Predicting calcium status post thyroidectomy with early calcium level. Otolaryngol Head Neck Surg 2002;127:289–93Google Scholar
5Lindblom, P, Westerdahl, J, Bergenfelz, A. Low parathyroid hormone levels after thyroid surgery: a feasible predictor of hypocalcaemia. Surgery 2002;131:515–20Google Scholar
6Payne, RJ, Hier, MP, Tamilia, M, Young, J, MacNamara, E, Black, MJ. Postoperative parathyroid hormone level as a predictor of post-thyroidectomy hypocalcaemia. J Otolaryngol 2003;32:362–7Google Scholar
7Graff, AT, Miller, FR, Roehm, CE, Prihoda, TJ. Predicting hypocalcaemia after total thyroidectomy: parathyroid hormone level vs. serial calcium levels. Ear Nose Throat J 2010;89:462–5Google Scholar
8Toniato, A, Boschin, IM, Piotto, A, Pelizzo, M, Sartori, P. Thyroidectomy and parathyroid hormone: tracing hypocalcaemia-prone patients. Am J Surg 2008;196:285–8Google Scholar
9Warren, FM, Andersen, PE, Wax, MK, Cohen, JI. Intraoperative parathyroid hormone levels in thyroid and parathyroid surgery. Laryngoscope 2002;112:1866–70CrossRefGoogle ScholarPubMed
10Seybt, MW, Terris, DJ. Outpatient, thyroidectomy: experience in, over 200 patients. Laryngoscope 2010;120:959–63Google Scholar
11Schwartz, AE, Clark, OH, Ituarte, P, Lo Gerfo, P. Therapeutic controversy: thyroid surgery--the choice. J Clin Endocrinol Metab 1998;83:1097–105Google ScholarPubMed
12Sahai, A, Symes, A, Jeddy, T. Short-stay thyroid surgery. Br J Surg 2005;92:58–9Google Scholar
13Bergamaschi, R, Becouarn, G, Ronceray, J, Arnaud, JP. Morbidity of thyroid surgery. Am J Surg 1998;176:71–5Google Scholar