title: Management of Completion and Total Thyroidectomy Patients Based on 1-Hour Postoperative Parathyroid Hormone.
abstract: After thyroid surgery, protocols based on postoperative parathyroid hormone (PTH) levels may prevent symptoms of hypocalcemia, while avoiding unnecessary prophylactic calcium and/or vitamin D supplementation. We examined the value of an initial management protocol based solely on a single PTH level measured one hour after completion or total thyroidectomy to prevent symptomatic hypocalcemia by conducting a retrospective review of 697 consecutive patients treated from July 2003 to April 2015. The proportion of patients who developed symptomatic hypocalcemia was similar between those treated before (n = 155) and after (n = 542) implementation of this 1-hour PTH protocol (16.8% vs 15.9%; P = 0.786). Those in the 1-hour PTH groups had lower overnight observation rates (97.4% vs 53.7%; P < 0.001) and length of stay (1.98 ± 2.61 vs 0.89 ± 1.87 days; P < 0.001), and required less calcium (3.9% vs 0.8%; P = 0.015) and vitamin D (2.6% vs 0%; P = 0.002) supplementation one year after surgery. Less than 1 per cent of patients discharged on the day of surgery in accordance with the 1-hour PTH guidelines returned to the emergency room for symptomatic hypocalcemia; none experienced significant morbidity. This protocol facilitates early discharge of low-risk patients and results in a similar or improved postoperative course compared with traditional overnight observation.
authors: Loma Linda University School of Medicine, Loma Linda, California, USA.
authors: Joshua
authors: J
authors: Park
authors: Ethan
authors: E
authors: Frank
authors: Alfred
authors: A
authors: Simental
authors: Sara
authors: S
authors: Yang
authors: Christopher
authors: C
authors: Vuong
authors: Steve
authors: S
authors: Lee
authors: Pedro Andrade
authors: PA
authors: Filho
mesh_terms: D000328:Adult; D000368:Aged; D002140:California; D015331:Cohort Studies; D019468:Disease Management; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000008:administration & dosage* / Q000097:blood; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone