Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurement.
BACKGROUND
We prospectively evaluated the possibility to make an early prediction of postthyroidectomy hypocalcemia by postoperative intact parathyroid hormone (iPTH) measurements.


METHODS
Fifty-three consecutive patients who underwent bilateral thyroid resection were included; iPTH was measured preoperatively, at the end of the surgical procedure, and at 2, 4, 6, 24, and 48 hours after the operation. Patients who had hypocalcemia (serum total calcium, <8.0 mg/dL) were compared with normocalcemic patients.


RESULTS
Sixteen patients experienced hypocalcemia. Six patients experienced symptoms. No significant difference was found between hypocalcemic and normocalcemic patients concerning demographic, pathologic, and preoperative laboratory data, surgical procedure, and intraoperative findings. Postoperative iPTH levels were reduced in hypocalcemic patients at the end of the procedure and at 2, 4, 6, 24, and 48 hours after the operation ( P < .001). IPTH levels below the normal range (<10 pg/mL) at 4 and 6 hours after the operation correctly predicted postoperative hypocalcemia and symptoms in all but 1 patient with a self-limiting, asymptomatic hypocalcemia (serum calcium concentration, 7.8 mg/dL) (specificity, 100%; sensitivity, 94%; overall accuracy, 98%).


CONCLUSIONS
One single iPTH measurement reliably can predict, early after thyroidectomy, which patients are prone to clinically relevant postoperative hypocalcemia and necessitate supplementation treatment and which patients are eligible for a safe early discharge.
Lombardi
Celestino Pio
CP
Division of Endocrine Surgery, Department of Surgery, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy.
Raffaelli
Marco
M
Princi
Pietro
P
Santini
Stefano
S
Boscherini
Mauro
M
De Crea
Carmela
C
Traini
Emanuela
E
D'Amore
Anna Maria
AM
Carrozza
Cinzia
C
Zuppi
Cecilia
C
Bellantone
Rocco
R
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013965:Thyroidectomy / Q000009:adverse effects*
D010281:Parathyroid Hormone