title: Postoperative PTH monitoring of hypocalcemia expedites discharge after thyroidectomy.
abstract: OBJECTIVE
  Hypocalcemia is the most common complication after total thyroidectomy. Some patients need to stay in the hospital for monitoring of hypocalcemic symptoms and serum calcium levels for several days. We investigated the efficacy and safety of using early postoperative parathyroid hormone (PTH) results for early discharge after thyroidectomy.
  
  
  METHODS
  A retrospective cohort study of 2 sequential groups of patients undergoing total thyroidectomy between January 2010 and March 2013 was undertaken. Patients were divided into 2 groups. In Group 1 (before June 2011), patients had daily monitoring of serum calcium level and hypocalcemic symptoms. They were discharged when calcium level was static and asymptomatic. Postoperative PTH was not utilized for discharge plan. In Group 2 (after June 2011), postoperative PTH and calcium level on day 1 were utilized to dictate subsequent management and discharge plan.
  
  
  RESULTS
  Of the 107 patients reviewed, 54 (50.5%) were in Group 1 and 53 (49.5%) were in Group 2. A total of 51 (47.7%) patients developed hypocalcemia. The two groups were comparable in demographic data, early postoperative PTH value, rate of hypocalcemia, the need for oral calcium and vitamin D supplements and rate of permanent hypoparathyroidism. Fewer patients in Group 2 experienced hypocalcemic symptoms, p=0.005. None of the patients in Group 2 needed intravenous calcium supplement (p=0.003). The median postoperative hospital stay for Group 1 was 4 days and for Group 2 was 1 day (p<0.0001).
  
  
  CONCLUSIONS
  Postoperative PTH level after total thyroidectomy facilitates early supplementation therapy and abates symptomatic hypocalcemia. It also allows early and safe patient discharge.
authors.affiliation: Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital, Hong Kong, China. Electronic address: tamlinc@yahoo.com.
authors.forename: Tam-Lin
authors.initials: TL
authors.lastname: Chow
authors.affiliation: Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital, Hong Kong, China.
authors.forename: Chi-Yee
authors.initials: CY
authors.lastname: Choi
authors.affiliation: Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital, Hong Kong, China.
authors.forename: Annie Nga-King
authors.initials: AN
authors.lastname: Chiu
mesh_terms: D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000175:diagnosis* / Q000209:etiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D010281:Parathyroid Hormone / Q000097:blood*; D011184:Postoperative Period; D013965:Thyroidectomy / Q000009:adverse effects
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium