Low serum iPTH at the end of surgery is the earliest predictor of postoperative hypocalcemia after total thyroidectomy.
Hypocalcemia
Hypoparathyroidism
Percentage decrease of iPTH
Symptomatic hypocalcemia
Total thyroidectomy
iPTH
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
30 Nov 2023
30 Nov 2023
Historique:
received:
07
09
2023
accepted:
26
11
2023
medline:
1
12
2023
pubmed:
30
11
2023
entrez:
29
11
2023
Statut:
epublish
Résumé
The most frequent complication of total thyroidectomy remains hypocalcemia due to low postoperative levels of serum intact parathyroid hormone (iPTH). The purpose of this study was to investigate the role of decreased iPTH at the end of surgery in predicting hypocalcemia. In addition, we examined the percentage decrease of iPTH as potential indicator of hypocalcemia. We retrospectively collected the data of patients who underwent total thyroidectomy for benign and malignant diseases at our institution between 2010 and 2022. The iPTH level was measured before and at the end of surgery, and serum calcium levels on the first postoperative day. Demographic, clinical, and biochemical characteristics of patients with low iPTH were compared with patients with normal iPTH levels using ANOVA for continuous variables and χ2-tests for categorical variables. Multivariable logistic regression analysis evaluated the association of iPTH at the end of surgery and the relative reduction of iPTH with postoperative hypocalcemia. The mean age of the 607 patients in this study was 55.6 years, and the female-to-male ratio was 5:1. Goiter was the most common indication for surgery (N = 382, 62.9%), followed by Graves' disease (N = 135, 22.2%). The mean preoperative iPTH was 49.0 pg/ml, while the mean postoperative iPTH was 29.3 pg/ml. A total of 197 patients (32.5%) had an iPTH level below normal, 77 patients (39%), had iPTH levels of 10-15.0 pg/ml and 120 patients (61%) of < 10.0 pg/ml at the end of surgery. Among all patients, 124 (20.4%) developed hypocalcemia on the first postoperative day. The mean percentage of decrease of iPTH was highest among patients with iPTH < 10 pg/ml (76.9%, p < 0.01); this group of patients had also the highest rate of postoperative hypocalcemia on day one (45.0% vs. 26.0% vs 12.2%, p < 0.01). Measurement of iPTH at the end of total thyroidectomy predicts patients who are at risk for postoperative hypocalcemia. The combination of low serum iPTH with a decrease in iPTH level of ≥ 50% may improve prediction of hypocalcemia compared to iPTH levels alone allowing for early calcium substitution in these patients at high risk of developing postoperative hypocalcemia.
Sections du résumé
BACKGROUND
BACKGROUND
The most frequent complication of total thyroidectomy remains hypocalcemia due to low postoperative levels of serum intact parathyroid hormone (iPTH). The purpose of this study was to investigate the role of decreased iPTH at the end of surgery in predicting hypocalcemia. In addition, we examined the percentage decrease of iPTH as potential indicator of hypocalcemia.
METHODS
METHODS
We retrospectively collected the data of patients who underwent total thyroidectomy for benign and malignant diseases at our institution between 2010 and 2022. The iPTH level was measured before and at the end of surgery, and serum calcium levels on the first postoperative day. Demographic, clinical, and biochemical characteristics of patients with low iPTH were compared with patients with normal iPTH levels using ANOVA for continuous variables and χ2-tests for categorical variables. Multivariable logistic regression analysis evaluated the association of iPTH at the end of surgery and the relative reduction of iPTH with postoperative hypocalcemia.
RESULTS
RESULTS
The mean age of the 607 patients in this study was 55.6 years, and the female-to-male ratio was 5:1. Goiter was the most common indication for surgery (N = 382, 62.9%), followed by Graves' disease (N = 135, 22.2%). The mean preoperative iPTH was 49.0 pg/ml, while the mean postoperative iPTH was 29.3 pg/ml. A total of 197 patients (32.5%) had an iPTH level below normal, 77 patients (39%), had iPTH levels of 10-15.0 pg/ml and 120 patients (61%) of < 10.0 pg/ml at the end of surgery. Among all patients, 124 (20.4%) developed hypocalcemia on the first postoperative day. The mean percentage of decrease of iPTH was highest among patients with iPTH < 10 pg/ml (76.9%, p < 0.01); this group of patients had also the highest rate of postoperative hypocalcemia on day one (45.0% vs. 26.0% vs 12.2%, p < 0.01).
CONCLUSIONS
CONCLUSIONS
Measurement of iPTH at the end of total thyroidectomy predicts patients who are at risk for postoperative hypocalcemia. The combination of low serum iPTH with a decrease in iPTH level of ≥ 50% may improve prediction of hypocalcemia compared to iPTH levels alone allowing for early calcium substitution in these patients at high risk of developing postoperative hypocalcemia.
Identifiants
pubmed: 38030913
doi: 10.1007/s00423-023-03194-8
pii: 10.1007/s00423-023-03194-8
pmc: PMC10687095
doi:
Substances chimiques
Calcium
SY7Q814VUP
Parathyroid Hormone
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
450Informations de copyright
© 2023. The Author(s).
Références
Nat Rev Endocrinol. 2018 Nov;14(11):670-683
pubmed: 30131586
Br J Surg. 2012 Apr;99(4):515-22
pubmed: 22287122
Int J Surg. 2018 Jul;55:46-50
pubmed: 29777882
Ann Surg Oncol. 2014 Nov;21(12):3844-52
pubmed: 24943236
World J Surg. 2008 Jul;32(7):1367-73
pubmed: 18340480
World J Surg. 2009 Mar;33(3):400-5
pubmed: 18958517
Langenbecks Arch Surg. 2012 Oct;397(7):1133-7
pubmed: 22976368
Br J Surg. 2019 Aug;106(9):1126-1137
pubmed: 31236917
Endocrinol Metab Clin North Am. 2018 Dec;47(4):759-770
pubmed: 30390811
J Int Med Res. 2021 Mar;49(3):300060521996911
pubmed: 33779362
Nat Rev Endocrinol. 2021 Mar;17(3):176-188
pubmed: 33339988
N Engl J Med. 2008 Jul 24;359(4):391-403
pubmed: 18650515
BJS Open. 2022 Sep 2;6(5):
pubmed: 36050906
J Surg Res. 2015 Aug;197(2):348-53
pubmed: 25982044
Eur Thyroid J. 2019 Oct;8(5):227-245
pubmed: 31768334
World J Surg. 2000 Aug;24(8):891-7
pubmed: 10865032
Thyroid. 2018 Jul;28(7):830-841
pubmed: 29848235
N Engl J Med. 2019 May 2;380(18):1738-1747
pubmed: 31042826
Am J Surg. 2011 May;201(5):570-4
pubmed: 21545901
Arch Surg. 2008 Feb;143(2):132-7; discussion 138
pubmed: 18283137
World J Surg. 2012 Jun;36(6):1300-6
pubmed: 22399155
Ann Oncol. 2019 Dec 1;30(12):1856-1883
pubmed: 31549998
Anat Sci Int. 2012 Sep;87(3):160-4
pubmed: 22689148
J Am Coll Surg. 2007 Dec;205(6):748-54
pubmed: 18035257
Thyroid. 2016 Jan;26(1):1-133
pubmed: 26462967
Thyroid. 2015 Jun;25(6):567-610
pubmed: 25810047
CA Cancer J Clin. 2018 Jan;68(1):55-63
pubmed: 29092098
Ann Surg. 2011 Nov;254(5):724-29; discussion 729-30
pubmed: 22005150