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.
Original language | English |
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Pages (from-to) | 748-754 |
Number of pages | 7 |
Journal | Journal of the American College of Surgeons |
Volume | 205 |
DOIs | |
Publication status | Published - 2007 |
Keywords
- Humans
- Hypocalcemia
- Parathyroid Hormone
- Predictive Value of Tests
- ROC Curve
- Thyroidectomy
- Time Factors