Same-day discharge after total thyroidectomy: the value of 6-hour serum parathyroid hormone and calcium levels.
BACKGROUND
The purpose of this study was to determine whether patients who undergo total thyroidectomy will have postoperative hypocalcemia develop when they reach the critical 6-hour serum levels defined as parathyroid hormone (PTH) > or =28 ng/L and simultaneous corrected calcium > or =2.14 mmol/L.


METHODS
This was a prospective study involving 70 consecutive total thyroidectomy patients. There were 51 women and 19 men involved in the study. The mean age was 49.3 years (range, 21-76 years). Patients who had completion thyroidectomy or neck dissections were excluded. Patients undergoing parathyroidectomy at the time of thyroidectomy were also excluded. PTH and corrected calcium levels were measured postoperatively at 6, 12, and 20 hours.


RESULTS
Hypocalcemia developed in 24% (17 of 70) of the patients. Of the 53 patients who remained normocalcemic, 68% (36 of 53) reached the 6-hour critical level. None of the hypocalcemic patients (0 of 17) attained the 6-hour critical level (chi-square test p < .0001). This translates into a specificity of 100% (95% confidence interval [CI], 80.5% to 100%) and a positive predictive value of 100% (95% CI, 90.1% to 100%).


CONCLUSIONS
The simultaneous evaluation of PTH and corrected calcium levels 6 hours after thyroidectomy allows for an accurate prediction of the trend of serum calcium. This study enables us to confidently consider same-day discharge for most of our thyroidectomy patients.
Payne
Richard J
RJ
Department of Otolaryngology--Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Cote Ste. Catherine, Suite E209, Montreal, Quebec, Canada H3T 1E2.
Hier
Michael P
MP
Tamilia
Michael
M
Mac Namara
Elizabeth
E
Young
Jonathan
J
Black
Martin J
MJ
D000328:Adult; D000368:Aged; D000465:Algorithms; D002118:Calcium / Q000097:blood*; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000175:diagnosis; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010351:Patient Discharge; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013965:Thyroidectomy; D013997:Time Factors
D010281:Parathyroid Hormone; D002118:Calcium