title: Early intact PTH (iPTH) is an early predictor of postoperative hypocalcemia for a safer and earlier hospital discharge: an analysis on 260 total thyroidectomies.
abstract: BACKGROUND
  Hypocalcemia is the most frequent complication after thyroidectomy. Serum calcium levels are reliable only 48-72 hours postoperatively. Early intact PTH (iPTH) has been proposed as early predictor of postoperative hypocalcemia. Our aim is to assess the ability of iPTH in predicting postoperative hypocalcemia.
  
  
  METHODS
  Two hundred and sixty patients underwent thyroidectomy with postoperative iPTH evaluation. The iPTH samplings were early performed after thyroidectomy. The calcium levels were dosed postoperatively. Age, sex, clinical diagnosis, obesity, comorbidities, previous neck surgery, preoperative therapy, type of surgery, dissectors used, lymphadenectomy, post-operative complications, reoperation and histological diagnosis were considered. The primary end-point was the postoperative hospital stay. The secondary end-points were serum calcium and iPTH. Three iPTH cut-offs were tested to assess which was the best value (10.0, 15.0, and 20.0 pg/mL).
  
  
  RESULTS
  The iPTH cut-off value of 10.0 pg/mL was the most accurate and specific for hypocalcemia. Comparing the iPTH value with the different values of calcium respectively 24 and 48 hours after surgery, a statistically stronger association with the serum calcium levels 48 hours postoperatively has been shown. iPTH ≥10 pg/mL 3-6 hours after surgery was strongly correlated to early discharge.
  
  
  CONCLUSIONS
  The correlation of iPTH with hypocalcemia is significant since a few hours after surgery and the value of iPTH ≥10 pg/mL is able to select those patients for a safe and early discharge. The use of the iPTH might avoid unnecessary extensions of hospitalization.
authors.affiliation: Division of General Surgery, Ospedale di Circolo, University of Insubria, Varese, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Inversini
authors.affiliation: Division of General Surgery, Ospedale di Circolo, University of Insubria, Varese, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rausei
authors.affiliation: Division of General Surgery, Ospedale di Circolo, University of Insubria, Varese, Italy.
authors.forename: Cesare Carlo
authors.initials: CC
authors.lastname: Ferrari
authors.affiliation: Division of General Surgery, Ospedale di Circolo, University of Insubria, Varese, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Frattini
authors.affiliation: Department of Surgery, Police General Hospital, Faculty of Medicine, Siam University, Bangkok, Thailand.
authors.forename: Angkoon
authors.initials: A
authors.lastname: Anuwong
authors.affiliation: Division of Breast and Endocrine Surgery, Department of Surgery, Minimally Invasive Surgery and Robotic Surgery Center, KUMC Thyroid Center, Korea University, Anam Hospital, Seoul, Korea.
authors.forename: Hoon Yub
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Division of Thyroid Surgery, China-Japan Union Hospital, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin University, Changchun 130033, China.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chei-Wei
authors.initials: CW
authors.lastname: Wu
authors.affiliation: Department of General Surgery, the Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Tian
authors.affiliation: Breast Cancer Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
authors.forename: Renbin
authors.initials: R
authors.lastname: Liu
authors.affiliation: Division of General Surgery, Ospedale di Circolo, University of Insubria, Varese, Italy.
authors.forename: Gianlorenzo
authors.initials: G
authors.lastname: Dionigi
keywords: Thyroid surgery; hospital discharge; hypocalcemia; intact PTH (iPTH)