Parathyroid hormone levels 4 hours after surgery do not accurately predict post-thyroidectomy hypocalcemia

Celestino Pio Lombardi, Marco Raffaelli, Pietro Princi, C Dobrinja, Cinzia Carrozza, Enrico Di Stasio, Annamaria D'Amore, Cecilia Zuppi, Rocco Domenico Alfonso Bellantone

Risultato della ricerca: Contributo in rivistaArticolo in rivista

100 Citazioni (Scopus)


BACKGROUND: We evaluated the reliability of intact parathyroid hormone (iPTH)levels 4 hours after thyroidectomy (4h-iPTH) as a predictor of hypocalcemia in a large series of patients. METHODS: A prospective experimental design involving 523 consecutive patients between September 1, 2004, and June 30, 2005, was employed. The specificity, sensitivity, and overall accuracy of 4h-iPTH in predicting post-thyroidectomy hypocalcemia and symptoms were determined. RESULTS: A total of 199 patients developed hypocalcemia (serum calcium concentrations <8.0 mg/dl). Five patients still were receiving vitamin D/oral calcium at 6 months after the operation. Seventy-three patients experienced mild symptoms. The 4h-iPTH levels were reduced in hypocalcemic patients (28.8 +/- 15.3 vs 11.2 +/- 11.6 pg/ml) (P < .001). The 4h-iPTH levels were within the normal range (10 to 65 pg/ml) in 360 patients (290 normocalcemic) and subnormal in 163 patients (129 hypocalcemic, of whom 62 were symptomatic). The accuracy of 4h-iPTH levels <10 pg/ml in predicting post-thyroidectomy hypocalcemia and symptoms was 80.1% and 78.6%, respectively. False-negative results were observed in 70 hypocalcemic patients (13.4%), 11 of whom were symptomatic (2.1%). CONCLUSIONS: Subnormal 4h-iPTH levels alone did not accurately predict clinically relevant postoperative hypocalcemia. The optimal cut-off level and its integration with preoperative and postoperative serum calcium concentrations should be reconsidered.
Lingua originaleEnglish
pagine (da-a)1016-1023
Numero di pagine8
Stato di pubblicazionePubblicato - 2006


  • Adolescent
  • Adult
  • Aged
  • Calcium
  • Female
  • Humans
  • Hypocalcemia
  • Male
  • Middle Aged
  • Parathyroid Hormone
  • Postoperative Period
  • Predictive Value of Tests
  • Prospective Studies
  • Sensitivity and Specificity
  • Thyroidectomy
  • Time Factors


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