[Serum PTH levels as a predictive factor of hypocalcaemia after total thyroidectomy].
BACKGROUND
Postoperative parathyroid hormone (PTH) levels as a predictor of hypocalcaemia in patients subjected to total thyroidectomy is analyzed.


METHODS
Prospective study involving 67 patients who underwent total thyroidectomy due to a benign disease. Serum PTH and ionised calcium were measured 20 h after surgery. Sensitivity, specificity and predictive values of PTH and ionised calcium levels were calculated to predict clinical and analytical hypocalcaemia.


RESULTS
A total of 42 (62.7%) patients developed hypocalcaemia (ionised calcium<0.95 mmol/l), but only 20 (29.9%) presented with symptoms. PTH concentration the day after surgery was significantly lower in the group that developed symptomatic hypocalcaemia (5.57+/-6.4 pg/ml) than in the asymptomatic (21.5+/-15.3 pg/ml) or normocalcaemic (26.8+/-24.9 pg/ml) groups (p=0.001). Taking the value of 13 pg/ml as a cut-off point of PTH levels, sensitivity, specificity, positive predictive value and negative predictive value were 54%, 72%, 76% and 48%, respectively. On the other hand, sensitivity for predicting symptomatic hypocalcaemia was 95% and specificity was 76%. The test showed a high incidence of false positives (11/30, 36%). Negative predictive value was 97% and positive predictive value was 65%. In multivariate analysis, PTH and ionised calcium were the only perioperative factors that showed an independent predictive value as risk indicators of symptomatic hypocalcaemia.


CONCLUSIONS
Normal PTH levels 20 h after surgery practically rule out the subsequent appearance of hypocalcaemia symptoms. On the other hand, low PTH levels are not necessarily associated to symptomatic hypocalcaemia due to the high number of false positives.
Díez Alonso
Manuel
M
Servicio de Cirugía General, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, España. mdiez.hupa@salud.madrid.org
Sánchez López
José Daniel
JD
Sánchez-Seco Peña
María Isabel
MI
Ratia Jiménez
Tomás
T
Arribas Gómez
Ignacio
I
Rodríguez Pascual
Angel
A
Martín-Duce
Antonio
A
Guadalix Hidalgo
Gregorio
G
Hernández Domínguez
Sara
S
Granell Vicent
Javier
J
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000097:blood* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D011182:Postoperative Care; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods
D010281:Parathyroid Hormone