title: One-hour PTH after thyroidectomy predicts symptomatic hypocalcemia.
abstract: BACKGROUND
  A major morbidity after total thyroidectomy is hypocalcemia. Although many clinical factors and laboratory studies have been correlated with both biochemical and symptomatic hypocalcemia, the ideal use and timing of these tests remain unclear. We hypothesize 1-h (PACU) parathyroid hormone (PTH) will identify patients at risk for symptomatic hypocalcemia.
  
  
  METHODS
  This prospective study evaluated 196 patients undergoing total thyroidectomy. Serum calcium and PTH levels were measured 1 h after surgery and on postoperative day 1 (POD1). Performance of a central compartment lymph node dissection, parathyroid autotransplantation, indication for procedure, pathology, and presence of parathyroid tissue in the pathology specimen were recorded.
  
  
  RESULTS
  Of 196 patients, nine (4.6%) developed symptomatic hypocalcemia. Thirty four (17.3%) had a 1-h PACU PTH ≤10 pg/dL, whereas 31 (15.8%) had a POD1 PTH of ≤10. Five (56%) of the nine symptomatic patients underwent central compartment lymph node dissection, four (44%) had parathyroid autotransplantation, and four (44%) had a PACU PTH ≤10. PACU and POD1 PTH levels were correlated (R(2) = 0.682). Multivariate regression identified central compartment dissection, autotransplantation, and PACU or POD1 PTH correlated with symptomatic hypocalcemia. PACU PTH, POD1 PTH, PACU Ca, malignant final pathology, and age ≤45 y correlated with biochemical hypocalcemia.
  
  
  CONCLUSIONS
  A 1-h postoperative PACU PTH is equivalent to POD1 PTH in predicting the development of symptomatic hypocalcemia. Biochemical hypocalcemia was not predictive of symptoms in the immediate postoperative period. Lymph node dissection and parathyroid autotransplantation correlated with symptomatic hypocalcemia and improve the sensitivity of biochemical screening alone.
authors.affiliation: Endocrine Surgery Research Group in the Department of Surgery, The University of Chicago Medicine 5841 S. Maryland Ave MC 4052, Chicago IL 60637.
authors.forename: Michael G
authors.initials: MG
authors.lastname: White
authors.affiliation: Endocrine Surgery Research Group in the Department of Surgery, The University of Chicago Medicine 5841 S. Maryland Ave MC 4052, Chicago IL 60637.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: James
authors.affiliation: Section of Otolaryngology in the Department of Surgery, The University of Chicago Medicine 5841 S. Maryland Ave MC 1035, Chicago IL 60637.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Nocon
authors.affiliation: Endocrine Surgery Research Group in the Department of Surgery, The University of Chicago Medicine 5841 S. Maryland Ave MC 4052, Chicago IL 60637.
authors.forename: Sapna
authors.initials: S
authors.lastname: Nagar
authors.affiliation: Endocrine Surgery Research Group in the Department of Surgery, The University of Chicago Medicine 5841 S. Maryland Ave MC 4052, Chicago IL 60637.
authors.forename: Edwin L
authors.initials: EL
authors.lastname: Kaplan
authors.affiliation: Section of Otolaryngology in the Department of Surgery, The University of Chicago Medicine 5841 S. Maryland Ave MC 1035, Chicago IL 60637.
authors.forename: Peter
authors.initials: P
authors.lastname: Angelos
authors.affiliation: Endocrine Surgery Research Group in the Department of Surgery, The University of Chicago Medicine 5841 S. Maryland Ave MC 4052, Chicago IL 60637.
authors.forename: Raymon H
authors.initials: RH
authors.lastname: Grogan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood*; D002648:Child; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013965:Thyroidectomy; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium
keywords: Calcium; Hypocalcemia; PTH; Symptomatic hypocalcemia; Thyroidectomy