title: Algorithm for early discharge after total thyroidectomy using PTH to predict hypocalcemia: prospective study.
abstract: OBJECTIVE
  Hypocalcemia is the most common complication after total thyroidectomy. The aim of this study was to determine whether postoperative parathyroid hormone (PTH) levels predict hypocalcemia in order to design an algorithm for early discharge.
  
  
  METHODS
  We present a prospective study including patients who underwent total thyroidectomy. Hypocalcemia was defined as serum ionized calcium < 1.09 mmol/L or clinical evidence of hypocalcemia. PTH measurement was performed preoperatively and at 1, 3, and 6 h postoperatively. The percent decline of preoperative values was calculated for each time point.
  
  
  RESULTS
  One hundred and six patients were included. Thirty-six (33.9%) patients presented hypocalcemia. A 50% decline in PTH levels at 3 h postoperatively showed the highest sensitivity and specificity to predict hypocalcemia (91 and 73%, respectively). No patients with a decrease <35% developed hypocalcemia (100% sensitivity), and all patients with a decrease >80% had hypocalcemia (100% specificity).
  
  
  CONCLUSIONS
  PTH determination at 3 h postoperatively is a reliable predictor of hypocalcemia. According to the proposed algorithm, patients with less than 80% drop in PTH levels can be safely discharged the day of the surgery.
authors.affiliation: Division of General Surgery, Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, 1118AAT, Buenos Aires, Argentina. fschlottmann@hotmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Schlottmann
authors.affiliation: Division of General Surgery, Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, 1118AAT, Buenos Aires, Argentina.
authors.forename: A L Campos
authors.initials: AL
authors.lastname: Arbulú
authors.affiliation: Division of General Surgery, Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, 1118AAT, Buenos Aires, Argentina.
authors.forename: E E
authors.initials: EE
authors.lastname: Sadava
authors.affiliation: Division of General Surgery, Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, 1118AAT, Buenos Aires, Argentina.
authors.forename: P
authors.initials: P
authors.lastname: Mendez
authors.affiliation: Division of General Surgery, Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, 1118AAT, Buenos Aires, Argentina.
authors.forename: L
authors.initials: L
authors.lastname: Pereyra
authors.affiliation: Division of General Surgery, Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, 1118AAT, Buenos Aires, Argentina.
authors.forename: J M
authors.initials: JM
authors.lastname: Fernández Vila
authors.affiliation: Division of General Surgery, Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, 1118AAT, Buenos Aires, Argentina.
authors.forename: N A
authors.initials: NA
authors.lastname: Mezzadri
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006996:Hypocalcemia / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010281:Parathyroid Hormone / Q000097:blood*; D010351:Patient Discharge; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone
keywords: Complications; Hypocalcemia; Parathyroid hormone; Postoperative; Predictors; Thyroidectomy