title: Postoperative hypoparathyroidism after thyroidectomy: efficient and cost-effective diagnosis and treatment.
abstract: BACKGROUND
  To describe a standardized, efficient, and cost-effective protocol for the diagnosis of temporary/persisting postoperative hypoparathyroidism after (total) thyroidectomy.
  
  
  METHODS
  We included 237 consecutive patients who underwent (total) thyroidectomy without central neck dissection for various indications. Serum calcium (sCa) and intact parathyroid hormone (iPTH) levels were measured prospectively on the morning of postoperative day 1 to predict the long-term parathyroid metabolism. On the morning of postoperative day 2, measurements were repeated. Follow-up was performed at 1 and 6 months postoperatively.
  
  
  RESULTS
  On the morning of postoperative day 1, patients with iPTH ≥ 15 pg/mL (178/237; 75%) and sCa > 2.0 mmol/L were normocalcemic, and "normal" parathyroid metabolism was predicted. iPTH levels of <10 pg/mL and sCa levels of ≤2.0 mmol/L were present in 33 of the 237 patients ("disturbed" parathyroid metabolism; 14%). A "gray zone" included patients with "uncertain" parathyroid metabolism demonstrating iPTH levels between 10 and 15 pg/mL (26/237; 11%). Patients with "disturbed" and "uncertain" parathyroid metabolism were given oral calcium and vitamin D. On the morning of the second postoperative day, iPTH turned to "normal" in 10 of those 26 (38%) patients, and no further calcium or vitamin D was given. During follow-up, supplemental calcium and vitamin D was able to be stopped in all but 2 patients ("permanent" hypoparathyroidism; 2/237; 0.8%).
  
  
  CONCLUSIONS
  Measurement of iPTH on the morning after operation allows accurate prediction of postoperative parathyroid function in ≥99% of cases. This simple recommendation is practicable in all surgical units, and is an efficient and cost-effective way to recognize patients who require calcium and vitamin D supplementation.
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University, Vienna, Austria. Electronic address: andreas.selberherr@meduniwien.ac.at.
authors.forename: Andreas
authors.initials: A
authors.lastname: Selberherr
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University, Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Scheuba
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University, Vienna, Austria.
authors.forename: Philipp
authors.initials: P
authors.lastname: Riss
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University, Vienna, Austria.
authors.forename: Bruno
authors.initials: B
authors.lastname: Niederle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000008:administration & dosage / Q000097:blood; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007011:Hypoparathyroidism / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000637:transplantation; D010281:Parathyroid Hormone / Q000097:blood; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D016606:Thyroid Nodule / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects*; D013997:Time Factors; D014182:Transplantation, Autologous; D014807:Vitamin D / Q000008:administration & dosage; D055815:Young Adult
chemical_list: C470125:PTH protein, human; D010281:Parathyroid Hormone; D014807:Vitamin D; D002118:Calcium