title: Hypocalcaemia following total thyroidectomy: early post-operative parathyroid hormone assay as a risk stratification and management tool.
abstract: OBJECTIVE
  To develop a practical, efficient and predictive algorithm to manage potential or actual post-operative hypocalcaemia after complete thyroidectomy, using a single post-operative parathyroid hormone assay.
  
  
  METHODS
  This paper reports a prospective study of 59 patients who underwent total or completion thyroidectomy over a period of 24 months. Parathyroid hormone levels were checked post-operatively on the day of surgery, and all patients were evaluated for hypocalcaemia both clinically and biochemically with serial corrected calcium measurements.
  
  
  RESULTS
  No patient with an early post-operative parathyroid hormone level of 23 ng/l or more (i.e. approximately twice the lower limit of the normal range) developed hypocalcaemia. All the patients who initially had post-operative hypocalcaemia but had an early parathyroid hormone level of 8 ng/l or more (i.e. approximately two-thirds of the lower limit of the normal range) had complete resolution of their hypocalcaemia within three months.
  
  
  CONCLUSIONS
  Early post-operative parathyroid hormone measurement can reliably predict patients at risk of post-thyroidectomy hypocalcaemia, and predict those patients expected to recover from temporary hypocalcaemia. A suggested post-operative management algorithm is presented.
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Birmingham Heartlands Hospital, UK.
authors.forename: S
authors.initials: S
authors.lastname: Islam
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Birmingham Heartlands Hospital, UK.
authors.forename: T
authors.initials: T
authors.lastname: Al Maqbali
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Birmingham Heartlands Hospital, UK.
authors.forename: D
authors.initials: D
authors.lastname: Howe
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Birmingham Heartlands Hospital, UK.
authors.forename: J
authors.initials: J
authors.lastname: Campbell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013965:Thyroidectomy / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone; D002118:Calcium