Research Article
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Year 2023, Volume: 14 Issue: 50, 197 - 203, 30.12.2023
https://doi.org/10.17944/interdiscip.1410405

Abstract

References

  • Zhu S, Pang Y, Xu J, Chen X, Zhang C, Wu B, et al. Endocrine Regulation on Bone by Thyroid. Frontiers in endocrinology. 2022;13:873820. https://doi.org/10.3389/fendo.2022.873820
  • Gac EP, Cabané TP, Amat VJ, Huidobro GF, Rossi FR, Rodríguez FF, et al. [Incidence of hypocalcemia after total thyroidectomy]. Revista medica de Chile. 2007;135(1):26-30. https://doi.org/10.4067/S0034-98872007000100004
  • Pepe J, Colangelo L, Biamonte F, Sonato C, Danese VC, Cecchetti V, et al. Diagnosis and management of hypocalcemia. Endocrine. 2020;69(3):485-95. https://doi.org/10.1007/s12020-020-02324-2
  • Warren FM, Andersen PE, Wax MK, Cohen JI. Perioperative parathyroid hormone levels in thyroid surgery: preliminary report. The Laryngoscope. 2004;114(4):689-93. https://doi.org/10.1097/00005537-200404000-00017
  • Husein M, Hier MP, Al-Abdulhadi K, Black M. Predicting calcium status post thyroidectomy with early calcium levels. Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2002;127(4):289-93. https://doi.org/10.1067/mhn.2002.127891
  • Shaha AR, Burnett C, Jaffe BM. Parathyroid autotransplantation during thyroid surgery. Journal of surgical oncology. 1991;46(1):21-4. https://doi.org/10.1002/jso.2930460106
  • Fahmy FF, Gillett D, Lolen Y, Shotton JC. Management of serum calcium levels in post-thyroidectomy patients. Clinical otolaryngology and allied sciences. 2004;29(6):735-9. https://doi.org/10.1111/j.1365-2273.2004.00895.x
  • Bove A, Bongarzoni G, Dragani G, Serafini F, Di Iorio A, Palone G, et al. Should female patients undergoing parathyroid-sparing total thyroidectomy receive routine prophylaxis for transient hypocalcemia? The American surgeon. 2004;70(6):533-6. https://doi.org/10.1177/000313480407000615
  • Erickson L. A. and Lloyd R. V. Pathology of the thyroid gland.Surg. Pathol. Head Neck 3rd Edn Inf. Healthc. N. Y.,2009;pp.1385-1428. https://doi.org/10.3109/9781420020373-22
  • Adams J, Andersen P, Everts E, Cohen J. Early postoperative calcium levels as predictors of hypocalcemia. The Laryngoscope. 1998;108(12):1829-31. https://doi.org/10.1097/00005537-199812000-00012
  • Erbil Y, Bozbora A, Ozbey N, Issever H, Aral F, Ozarmagan S, et al. Predictive value of age and serum parathormone and vitamin d3 levels for postoperative hypocalcemia after total thyroidectomy for nontoxic multinodular goiter. Archives of surgery (Chicago, Ill : 1960). 2007;142(12):1182-7. https://doi.org/10.1001/archsurg.142.12.1182
  • Asari R, Passler C, Kaczirek K, Scheuba C, Niederle B. Hypoparathyroidism after total thyroidectomy: a prospective study. Archives of surgery (Chicago, Ill : 1960). 2008;143(2):132-7; discussion 8. https://doi.org/10.1001/archsurg.2007.55
  • Lefevre JH, Tresallet C, Leenhardt L, Jublanc C, Chigot JP, Menegaux F. Reoperative surgery for thyroid disease. Langenbeck’s archives of surgery. 2007;392(6):685-91. https://doi.org/10.1007/s00423-007-0201-6
  • AlQahtani A, Parsyan A, Payne R, Tabah R. Parathyroid hormone levels 1 hour after thyroidectomy: an early predictor of postoperative hypocalcemia. Canadian journal of surgery Journal canadien de chirurgie. 2014;57(4):237-40. https://doi.org/10.1503/cjs.008013
  • Schlottmann F, Arbulú AL, Sadava EE, Mendez P, Pereyra L, Fernández Vila JM, et al. Algorithm for early discharge after total thyroidectomy using PTH to predict hypocalcemia: prospective study. Langenbeck’s archives of surgery. 2015;400(7):831-6. https://doi.org/10.1007/s00423-015-1341-8
  • Karatzanis AD, Ierodiakonou DP, Fountakis ES, Velegrakis SG, Doulaptsi MV, Prokopakis EP, et al. Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy. Head & neck. 2018;40(5):1040-5. https://doi.org/10.1002/hed.25081
  • Uruno T, Miyauchi A, Shimizu K, Tomoda C, Takamura Y, Ito Y, et al. A prophylactic infusion of calcium solution reduces the risk of symptomatic hypocalcemia in patients after total thyroidectomy. World journal of surgery. 2006;30(3):304-8. https://doi.org/10.1007/s00268-005-0374-5
  • Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, et al. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World journal of surgery. 1998;22(7):718-24. https://doi.org/10.1007/s002689900459
  • Acun Z, Cihan A, Ulukent SC, Comert M, Ucan B, Cakmak GK, et al. A randomized prospective study of complications between general surgery residents and attending surgeons in near-total thyroidectomies. Surgery today. 2004;34(12):997-1001. https://doi.org/10.1007/s00595-004-2857-7
  • Orloff LA, Wiseman SM, Bernet VJ, Fahey TJ, 3rd, Shaha AR, Shindo ML, et al. American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults. Thyroid : official journal of the American Thyroid Association. 2018;28(7):830-41. https://doi.org/10.1089/thy.2017.0309
  • Murray TM, Rao LG, Divieti P, Bringhurst FR. Parathyroid hormone secretion and action: evidence for discrete receptors for the carboxyl-terminal region and related biological actions of carboxyl- terminal ligands. Endocrine reviews. 2005;26(1):78-113. https://doi.org/10.1210/er.2003-0024
  • Vescan A, Witterick I, Freeman J. Parathyroid hormone as a predictor of hypocalcemia after thyroidectomy. The Laryngoscope. 2005;115(12):2105-8. https://doi.org/10.1097/01.MLG.0000181504.69230.87
  • Saba A, Podda M, Messina Campanella A, Pisanu A. Early prediction of hypocalcemia following thyroid surgery. A prospective randomized clinical trial. Langenbeck’s archives of surgery. 2017;402(7):1119-25. https://doi.org/10.1007/s00423-017-1586-5
  • Lecerf P, Orry D, Perrodeau E, Lhommet C, Charretier C, Mor C, et al. Parathyroid hormone decline 4 hours after total thyroidectomy accurately predicts hypocalcemia. Surgery. 2012;152(5):863-8. https://doi.org/10.1016/j.surg.2012.03.011
  • Inversini D, Rausei S, Ferrari CC, Frattini F, Anuwong A, Kim HY, et al. Early intact PTH (iPTH) is an early predictor of postoperative hypocalcemia for a safer and earlier hospital discharge: an analysis on 260 total thyroidectomies. Gland surgery. 2016;5(5):522-8. https://doi.org/10.21037/gs.2016.09.08
  • Suwannasarn M, Jongjaroenprasert W, Chayangsu P, Suvikapakornkul R, Sriphrapradang C. Single measurement of intact parathyroid hormone after thyroidectomy can predict transient and permanent hypoparathyroidism: a prospective study. Asian journal of surgery. 2017;40(5):350-6. https://doi.org/10.1016/j.asjsur.2015.11.005
  • Al-Dhahri SF, Mubasher M, Al-Muhawas F, Alessa M, Terkawi RS, Terkawi AS. Early prediction of oral calcium and vitamin D requirements in post-thyroidectomy hypocalcemia. Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2014;151(3):407-14. https://doi.org/10.1177/0194599814536848
  • Lale A, Öz B, Akcan AC, Sözüer EM, Arıkan TB, Gök M. Determination of risk factors causing hypocalcaemia after thyroid surgery. Asian journal of surgery. 2019;42(9):883-9. https://doi.org/10.1016/j.asjsur.2018.12.009
  • Bove A, Di Renzo RM, Palone G, D’Addetta V, Percario R, Panaccio P, et al. Early biomarkers of hypocalcemia following total thyroidectomy. International journal of surgery (London, England). 2014;12 Suppl 1:S202-4. https://doi.org/10.1016/j.ijsu.2014.05.008

Can the risk of hypocalcemia be detected with intact parathyroid hormone level after total thyroidectomy?

Year 2023, Volume: 14 Issue: 50, 197 - 203, 30.12.2023
https://doi.org/10.17944/interdiscip.1410405

Abstract

Objective: Nowadays, thyroidectomy is performed in patients with various indications. However, transient or permanent hypocalcemia occurs after surgery. In this case, the duration of hospitalization of the patients is prolonged. In this study, we aimed to detect hypocalcemia in the early phase with intact parathyroid hormone (iPTH), a biochemical marker.

Method: Hospital records of patients who had undergone standard bilateral total thyroidectomy for thyroid disease were retrospectively analyzed between September 2018 and April 2019 at the Department of General Surgery, Gaziantep University.

Results: Of the 114 patients included in the study, 91 were female (79.8%), and 23 were male (23%). Calcium levels of ≤8.5 mg/dL were found in 49 of 114 patients. Clinical symptoms of hypocalcemia were observed in 19 of these 49 patients. There was a significant correlation between the patients’ iPTH levels at 3-6 hours postoperatively and the calcium values at 24 hours postoperatively (p<0.05). In addition, a significant, positive and weak correlation was found between the iPTH level and the iPTH level at 24 hours postoperatively and the Ca level at 24 hours postoperatively (p<0.05). The iPTH level measured between 3 and 6 hours postoperatively can predict hypocalcemia with a sensitivity of 77.5% and a specificity of 40.3%.

Conclusion: Postoperative hypocalcemia can be predicted with iPTH in the early period. The serum iPTH value has been concluded to be an effective parameter that can be used to predict postoperative hypocalcemia.

References

  • Zhu S, Pang Y, Xu J, Chen X, Zhang C, Wu B, et al. Endocrine Regulation on Bone by Thyroid. Frontiers in endocrinology. 2022;13:873820. https://doi.org/10.3389/fendo.2022.873820
  • Gac EP, Cabané TP, Amat VJ, Huidobro GF, Rossi FR, Rodríguez FF, et al. [Incidence of hypocalcemia after total thyroidectomy]. Revista medica de Chile. 2007;135(1):26-30. https://doi.org/10.4067/S0034-98872007000100004
  • Pepe J, Colangelo L, Biamonte F, Sonato C, Danese VC, Cecchetti V, et al. Diagnosis and management of hypocalcemia. Endocrine. 2020;69(3):485-95. https://doi.org/10.1007/s12020-020-02324-2
  • Warren FM, Andersen PE, Wax MK, Cohen JI. Perioperative parathyroid hormone levels in thyroid surgery: preliminary report. The Laryngoscope. 2004;114(4):689-93. https://doi.org/10.1097/00005537-200404000-00017
  • Husein M, Hier MP, Al-Abdulhadi K, Black M. Predicting calcium status post thyroidectomy with early calcium levels. Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2002;127(4):289-93. https://doi.org/10.1067/mhn.2002.127891
  • Shaha AR, Burnett C, Jaffe BM. Parathyroid autotransplantation during thyroid surgery. Journal of surgical oncology. 1991;46(1):21-4. https://doi.org/10.1002/jso.2930460106
  • Fahmy FF, Gillett D, Lolen Y, Shotton JC. Management of serum calcium levels in post-thyroidectomy patients. Clinical otolaryngology and allied sciences. 2004;29(6):735-9. https://doi.org/10.1111/j.1365-2273.2004.00895.x
  • Bove A, Bongarzoni G, Dragani G, Serafini F, Di Iorio A, Palone G, et al. Should female patients undergoing parathyroid-sparing total thyroidectomy receive routine prophylaxis for transient hypocalcemia? The American surgeon. 2004;70(6):533-6. https://doi.org/10.1177/000313480407000615
  • Erickson L. A. and Lloyd R. V. Pathology of the thyroid gland.Surg. Pathol. Head Neck 3rd Edn Inf. Healthc. N. Y.,2009;pp.1385-1428. https://doi.org/10.3109/9781420020373-22
  • Adams J, Andersen P, Everts E, Cohen J. Early postoperative calcium levels as predictors of hypocalcemia. The Laryngoscope. 1998;108(12):1829-31. https://doi.org/10.1097/00005537-199812000-00012
  • Erbil Y, Bozbora A, Ozbey N, Issever H, Aral F, Ozarmagan S, et al. Predictive value of age and serum parathormone and vitamin d3 levels for postoperative hypocalcemia after total thyroidectomy for nontoxic multinodular goiter. Archives of surgery (Chicago, Ill : 1960). 2007;142(12):1182-7. https://doi.org/10.1001/archsurg.142.12.1182
  • Asari R, Passler C, Kaczirek K, Scheuba C, Niederle B. Hypoparathyroidism after total thyroidectomy: a prospective study. Archives of surgery (Chicago, Ill : 1960). 2008;143(2):132-7; discussion 8. https://doi.org/10.1001/archsurg.2007.55
  • Lefevre JH, Tresallet C, Leenhardt L, Jublanc C, Chigot JP, Menegaux F. Reoperative surgery for thyroid disease. Langenbeck’s archives of surgery. 2007;392(6):685-91. https://doi.org/10.1007/s00423-007-0201-6
  • AlQahtani A, Parsyan A, Payne R, Tabah R. Parathyroid hormone levels 1 hour after thyroidectomy: an early predictor of postoperative hypocalcemia. Canadian journal of surgery Journal canadien de chirurgie. 2014;57(4):237-40. https://doi.org/10.1503/cjs.008013
  • Schlottmann F, Arbulú AL, Sadava EE, Mendez P, Pereyra L, Fernández Vila JM, et al. Algorithm for early discharge after total thyroidectomy using PTH to predict hypocalcemia: prospective study. Langenbeck’s archives of surgery. 2015;400(7):831-6. https://doi.org/10.1007/s00423-015-1341-8
  • Karatzanis AD, Ierodiakonou DP, Fountakis ES, Velegrakis SG, Doulaptsi MV, Prokopakis EP, et al. Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy. Head & neck. 2018;40(5):1040-5. https://doi.org/10.1002/hed.25081
  • Uruno T, Miyauchi A, Shimizu K, Tomoda C, Takamura Y, Ito Y, et al. A prophylactic infusion of calcium solution reduces the risk of symptomatic hypocalcemia in patients after total thyroidectomy. World journal of surgery. 2006;30(3):304-8. https://doi.org/10.1007/s00268-005-0374-5
  • Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, et al. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World journal of surgery. 1998;22(7):718-24. https://doi.org/10.1007/s002689900459
  • Acun Z, Cihan A, Ulukent SC, Comert M, Ucan B, Cakmak GK, et al. A randomized prospective study of complications between general surgery residents and attending surgeons in near-total thyroidectomies. Surgery today. 2004;34(12):997-1001. https://doi.org/10.1007/s00595-004-2857-7
  • Orloff LA, Wiseman SM, Bernet VJ, Fahey TJ, 3rd, Shaha AR, Shindo ML, et al. American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults. Thyroid : official journal of the American Thyroid Association. 2018;28(7):830-41. https://doi.org/10.1089/thy.2017.0309
  • Murray TM, Rao LG, Divieti P, Bringhurst FR. Parathyroid hormone secretion and action: evidence for discrete receptors for the carboxyl-terminal region and related biological actions of carboxyl- terminal ligands. Endocrine reviews. 2005;26(1):78-113. https://doi.org/10.1210/er.2003-0024
  • Vescan A, Witterick I, Freeman J. Parathyroid hormone as a predictor of hypocalcemia after thyroidectomy. The Laryngoscope. 2005;115(12):2105-8. https://doi.org/10.1097/01.MLG.0000181504.69230.87
  • Saba A, Podda M, Messina Campanella A, Pisanu A. Early prediction of hypocalcemia following thyroid surgery. A prospective randomized clinical trial. Langenbeck’s archives of surgery. 2017;402(7):1119-25. https://doi.org/10.1007/s00423-017-1586-5
  • Lecerf P, Orry D, Perrodeau E, Lhommet C, Charretier C, Mor C, et al. Parathyroid hormone decline 4 hours after total thyroidectomy accurately predicts hypocalcemia. Surgery. 2012;152(5):863-8. https://doi.org/10.1016/j.surg.2012.03.011
  • Inversini D, Rausei S, Ferrari CC, Frattini F, Anuwong A, Kim HY, et al. Early intact PTH (iPTH) is an early predictor of postoperative hypocalcemia for a safer and earlier hospital discharge: an analysis on 260 total thyroidectomies. Gland surgery. 2016;5(5):522-8. https://doi.org/10.21037/gs.2016.09.08
  • Suwannasarn M, Jongjaroenprasert W, Chayangsu P, Suvikapakornkul R, Sriphrapradang C. Single measurement of intact parathyroid hormone after thyroidectomy can predict transient and permanent hypoparathyroidism: a prospective study. Asian journal of surgery. 2017;40(5):350-6. https://doi.org/10.1016/j.asjsur.2015.11.005
  • Al-Dhahri SF, Mubasher M, Al-Muhawas F, Alessa M, Terkawi RS, Terkawi AS. Early prediction of oral calcium and vitamin D requirements in post-thyroidectomy hypocalcemia. Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2014;151(3):407-14. https://doi.org/10.1177/0194599814536848
  • Lale A, Öz B, Akcan AC, Sözüer EM, Arıkan TB, Gök M. Determination of risk factors causing hypocalcaemia after thyroid surgery. Asian journal of surgery. 2019;42(9):883-9. https://doi.org/10.1016/j.asjsur.2018.12.009
  • Bove A, Di Renzo RM, Palone G, D’Addetta V, Percario R, Panaccio P, et al. Early biomarkers of hypocalcemia following total thyroidectomy. International journal of surgery (London, England). 2014;12 Suppl 1:S202-4. https://doi.org/10.1016/j.ijsu.2014.05.008
There are 29 citations in total.

Details

Primary Language English
Subjects Clinical Sciences (Other)
Journal Section Research Articles
Authors

Adil Haciboncuk 0000-0002-8959-0435

Alper Aytekin 0000-0003-2872-5276

Latif Yılmaz 0000-0003-2528-9691

Nurullah Bilen 0000-0002-4631-0333

Aziz Bulut 0000-0001-6613-3082

Publication Date December 30, 2023
Submission Date December 19, 2022
Published in Issue Year 2023 Volume: 14 Issue: 50

Cite

Vancouver Haciboncuk A, Aytekin A, Yılmaz L, Bilen N, Bulut A. Can the risk of hypocalcemia be detected with intact parathyroid hormone level after total thyroidectomy?. Interdiscip Med J. 2023;14(50):197-203.