Postoperative PTH measurement facilitates day 1 discharge    after total thyroidectomy.
OBJECTIVE
A new protocol for postoperative calcium management was developed with the aim of achieving an increase in the proportion of patients being safely discharged on the first postoperative day. We present our experience with the first 50 patients treated under this new protocol.


METHODS
A cohort study was performed involving the first 50 patients admitted for total or completion thyroidectomy, those data were then compared with a control group. Intact PTH (iPTH) was measured at 4-h postoperatively and patients with iPTH in the normal range were discharged on the first postoperative day.


RESULTS
Mean age and sex distribution were similar in both groups. Mean lowest postoperative corrected calcium levels in the study group were 2.19 mmol/l and 2.15 mmol/l in the control group (P = 0.24). Parathyroid auto-transplantation was associated with low PTH levels (risk ratio = 0.49). Over 50% of patients (n = 27) were successfully discharged on the first postoperative day in the study group and no patient required readmission. Length of stay was significantly shorter in the study group, mean 1.64 vs. 2.20 days (P < 0.05).


CONCLUSIONS
The use of iPTH accurately predicts hypocalcaemia after total thyroidectomy and can be used to facilitate safe early discharge for patients.
Endocrine Surgical Unit, University of Sydney, Sydney, Australia. grodski@yahoo.com
Simon
S
Grodski
Catharina Ihre
CI
Lundgren
Stan
S
Sidhu
Mark
M
Sywak
Leigh
L
Delbridge
D002118:Calcium / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*; D007118:Immunoassay / Q000379:methods*; 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; D013965:Thyroidectomy / Q000009:adverse effects*; D013997:Time Factors
D010281:Parathyroid Hormone; D002118:Calcium