Is Decline Rate of Intact Parathyroid Hormone Level a Reliable Criterion for Early Discharge of Patients after Total Thyroidectomy?

Document Type : Original

Authors

Department of Surgery, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Abstract

Introduction:
Parathyroid dysfunction leading to symptomatic hypocalcemia is not uncommon following a total thyroidectomy and is often associated with significant patient morbidity and a prolonged hospital stay. The current study aimed at evaluating the comparative predictive role of serum calcium and intact parathyroid hormone (iPTH) for post-thyroidectomy hypocalcemia.
 
Materials and Methods:
This prospective study was performed in 83 consecutive patients undergoing total thyroidectomy. Laboratory data such as serum calcium, vitamin D level, serum iPTH and serum phosphorus levels before surgery, postoperative calcium, and PTH levels measured after 1 and 6 hours and on the first postoperative day (1POD) were recorded.
 
Results:
Among the 83 patients, the mean (SD) age was 45.87 (12.57) years (range, 21–72 years); 70 (84.3%) patients were female. Final pathology was benign for 47 (56.6%) patients and malignant for 36 (43.4%) patients. In total, lymph node dissections were performed in 19 subjects (22.9%). On histological examination of the specimens, the parathyroid gland was found to have been removed inadvertently in 13 (15.7%) cases. In total, 35 (40.9%) patients developed hypocalcemia after thyroidectomy; receiver operating characteristic (ROC) analysis showed that a cut-off value of 15.39 pg/ml for iPTH, with a decline rate of 73% 1 hour after thyroidectomy is a significant predictor of hypocalcemia (area under the curve [AUC], 0.878; 95% confidence interval [CI], 0.79–0.96, P<0.0001) compared with calcium  
Conclusion:
The current study showed that the decline rate in iPTH is a more reliable factor for hypocalcemia after total thyroidectomy than serum calcium. Patients with a decline rate <73% in iPTH could be discharged at 1POD without supplementation.

Keywords

Main Subjects

References

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Iranian Journal of Otorhinolaryngology
Volume 29, Issue 5 - Serial Number 94
September and October 2017
Pages 239-246

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