title: Pre-operative serum alkaline phosphatase as a predictive indicator of post-operative hypocalcaemia in patients undergoing total thyroidectomy.
abstract: OBJECTIVE
  This study aimed to evaluate whether a pre-operative elevated serum alkaline phosphatase level is a potential predictor of post-operative hypocalcaemia after total thyroidectomy.
  
  
  METHODS
  Data was retrospectively collected from the case notes of patients who had undergone total thyroidectomy. Patients were divided into Graves' disease and non-Graves' groups. Pre-operative and post-operative biochemical markers, including serum calcium, alkaline phosphatase and parathyroid hormone levels, were reviewed.
  
  
  RESULTS
  A total of 225 patients met the inclusion criteria. Graves' disease was the most common indication (n = 134; 59.5 per cent) for thyroidectomy. Post-operative hypocalcaemia developed in 48 patients (21.3 per cent) and raised pre-operative serum alkaline phosphatase was noted in 94 patients (41.8 per cent). Raised pre-operative serum alkaline phosphatase was significantly associated with post-operative hypocalcaemia, particularly in Graves' disease patients (p < 0.05).
  
  
  CONCLUSIONS
  Pre-operative serum alkaline phosphatase measurements help to predict post-thyroidectomy hypocalcaemia, especially in patients who do not develop hypoparathyroidism. Ascertaining the pre-operative serum alkaline phosphatase level in patients undergoing total thyroidectomy may help surgeons to identify at-risk patients.
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery,Ninewells Hospital and University of Dundee Medical School,Scotland,UK.
authors.forename: M S
authors.initials: MS
authors.lastname: Miah
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery,Ninewells Hospital and University of Dundee Medical School,Scotland,UK.
authors.forename: S
authors.initials: S
authors.lastname: Mahendran
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery,Ninewells Hospital and University of Dundee Medical School,Scotland,UK.
authors.forename: C
authors.initials: C
authors.lastname: Mak
authors.affiliation: Department of Endocrinology,Ninewells Hospital and University of Dundee Medical School,Scotland,UK.
authors.forename: G
authors.initials: G
authors.lastname: Leese
authors.affiliation: Department of General Surgery,Ninewells Hospital and University of Dundee Medical School,Scotland,UK.
authors.forename: D
authors.initials: D
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood*; D005260:Female; D006111:Graves Disease / Q000601:surgery; D006801:Humans; D006996:Hypocalcemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013959:Thyroid Diseases / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D000469:Alkaline Phosphatase; D002118:Calcium
keywords: Alkaline Phosphatase; Graves Disease; Hypocalcemia; Thyroidectomy