title: Early prediction of post-thyroidectomy hypocalcemia by early parathyroid hormone measurement.
abstract: OBJECTIVE
  Hypoparathyroidism is the most common complication of total thyroidectomy (TT). Postthyroidectomy hypocalcemia occurs 24 to 48 hours after the operation. It prolongs the length of hospital stay, even though transient in most cases. The aim of this study was to predetermine the patients who may develop postthyroidectomy hypocalcemia by using early postoperative serum intact parathormone (iPTH) and calcium (Ca2+) measurements, and to investigate the effects of early initiated oral calcium and vitamin D treatments on the development of transient hypocalcemia.
  
  
  METHODS
  Patients who underwent TT after initiation of the early iPTH measurement protocol in January 2013 were included into the study group (Group 1, n=202). The control group (Group 2) was composed of 72 patients who underwent TT before the protocol. Prior to the initiation of the protocol, Ca2+ was measured instead of iPTH. In the study group, the serum Ca2+ and iPTH levels were measured before surgery, and 1 and 24-hours after. A calcium level below 8 mg/dL was accepted as biochemical hypocalcaemia, and a iPTH level under 15pg/mL was accepted as hypoparathyroidism. In the study group, patients with below normal iPTH levels were treated with prophylactic oral calcium and vitamin D.
  
  
  RESULTS
  In Group 1, 15.8% (n=32) of the patients had hypoparathyroidism on the 1h and 24 h iPTH measurements. There was no statistically difference with regard to PTH levels measured in the postoperative 1st hour and at the 24th hour (p= 0.078). Biochemical hypocalcaemia developed in 16 (7.9%) and 13 (18%) patients in Groups 1 and 2, respectively, 24 hours after thyroidectomy (p<0.05). Mean length of hospital stay was 2.17 and 3.26 days in the study and control groups (p<0.001).
  
  
  CONCLUSIONS
  We believe that the measurement of iPTH levels one hour after thyroidectomy, when compared to levels at 24 hours after procedure, is a safe, reliable, and adequate method for the effective management of plausible postthyroidectomic hypocalcemia. It yields significantly shorter hospital stay periods.
  
  
  BACKGROUND
  Calcium, Hypoparathyroidism, Postoperative complication, Total thyroidectomy.
authors.forename: Gurkan
authors.initials: G
authors.lastname: Yetkin
authors.forename: Bulent
authors.initials: B
authors.lastname: Citgez
authors.forename: Pinar
authors.initials: P
authors.lastname: Yazici
authors.forename: Mehmet
authors.initials: M
authors.lastname: Mihmanli
authors.forename: Erhan
authors.initials: E
authors.lastname: Sit
authors.forename: Mehmet
authors.initials: M
authors.lastname: Uludag
mesh_terms: D000293:Adolescent; D000328:Adult; D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood / Q000627:therapeutic use; D042241:Early Diagnosis; D005260:Female; D006044:Goiter, Nodular / Q000601:surgery; D006801:Humans; D006996:Hypocalcemia / Q000097:blood* / Q000209:etiology / Q000517:prevention & control; D007011:Hypoparathyroidism / Q000209:etiology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000293:injuries; D010281:Parathyroid Hormone / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood* / Q000209:etiology; D011184:Postoperative Period; D013965:Thyroidectomy; D014807:Vitamin D / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone; D014807:Vitamin D; D002118:Calcium