TY - JOUR
T1 - Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies
AU - Noordzij, Jp
AU - Lee, Sl
AU - Bernet, Vj
AU - Payne, Rj
AU - Cohen, Sm
AU - Mcleod, Ik
AU - Hier, Mp
AU - Black, Mj
AU - Kerr, Pd
AU - Richards, Ml
AU - Lo, Cy
AU - Raffaelli, Marco
AU - Bellantone, Rocco Domenico Alfonso
AU - Lombardi, Celestino Pio
AU - Cohen, Ji
AU - Dietrich,
PY - 2007
Y1 - 2007
N2 - 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.
AB - 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.
KW - Humans
KW - Hypocalcemia
KW - Parathyroid Hormone
KW - Predictive Value of Tests
KW - ROC Curve
KW - Thyroidectomy
KW - Time Factors
KW - Humans
KW - Hypocalcemia
KW - Parathyroid Hormone
KW - Predictive Value of Tests
KW - ROC Curve
KW - Thyroidectomy
KW - Time Factors
UR - http://hdl.handle.net/10807/14400
U2 - 10.1016/j.jamcollsurg.2007.06.298
DO - 10.1016/j.jamcollsurg.2007.06.298
M3 - Article
SN - 1072-7515
VL - 205
SP - 748
EP - 754
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
ER -