Abstract
Purpose
Hypoparathyroidism is one of the most common and most feared complications of total thyroidectomy (TT). The aim of this study is to detect possible markers that may facilitate early tracing of hypocalcaemia-prone patients in order to reduce clinical cost by optimizing patient discharge and to avoid unnecessary treatment.
Methods
Over an 18-month period, 995 patients, 23 % male and 77 % female, aged 52.9 ± 13.4 years, underwent TT in ten Lombardy hospitals. The following parameters were analyzed: calcaemia before and 12–24 and 48 h after surgery, pre- and post-operative parathyroid hormone (PTH) at 24 h and pre-operative 25OH vitamin D.
Results
Mortality was nil and morbidity was 22.4 %. Mean 24-h calcaemia and PTH were 2.17 ± 0.15 mmol/l and 31.81 ± 20.35 pg/ml, respectively; mean 24-h PTH decay was 36.7 ± 34.12 %. Four hundred seventy-three (47.5 %) patients were hypocalcaemic at discharge; 142 of whom had transient hypoparathyroidism that became permanent in 27. Patients developing hypocalcaemia had significantly higher values of PTH and calcium decay. At multiple logistic regression, only 24-h calcium decay, PTH drop and the presence of symptoms and parathyroid auto-grafting were significantly related to hypoparathyroidism. The association of these factors had a 99.2 % negative predictive value (NPV) for the development of hypoparathyroidism. A 70 % PTH drop had a 93.75 NPV for transient hypoparathyroidism. A 12 % calcaemia decay had a 95.7 NPV for hypoparathyroidism.
Conclusions
Hypocalcaemic asymptomatic patients with less than 70 % PTH and 12 % calcaemia decay may be safely discharged without treatment. Symptomatic patients and those with parathyroid grafting should receive calcium and vitamin D.
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References
Bergenfelz A, Jansson S, Kristoffersson A et al (2008) Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbeck’s Arch Surg / Deut Ges Chirurgie 393:667–673
Grodski S, Serpell J (2008) Evidence for the role of perioperative PTH measurement after total thyroidectomy as a predictor of hypocalcemia. World J Surg 32:1367–1373
Sitges-Serra A, Ruiz S, Girvent M et al (2010) Outcome of protracted hypoparathyroidism after total thyroidectomy. Br J Surg 97:1687–1695
Lazard DS, Godiris-Petit G, Wagner I et al (2012) Early detection of hypocalcemia after total/completion thyroidectomy: routinely usable algorithm based on serum calcium level. World J Surg 36:2590–2597
Lombardi CP, Raffaelli M, Princi P et al (2004) Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurement. Surgery 136:1236–1241
Lombardi CP, Raffaelli M, Princi P et al (2006) Parathyroid hormone levels 4 hours after surgery do not accurately predict post-thyroidectomy hypocalcemia. Surgery 140:1016–1023, discussion 1023-1015
Bellantone R, Lombardi CP, Raffaelli M et al (2002) Is routine supplementation therapy (calcium and vitamin D) useful after total thyroidectomy? Surgery 132:1109–1112, discussion 1112-1103
Wang TS, Cheung K, Roman SA et al (2011) To supplement or not to supplement: a cost-utility analysis of calcium and vitamin D repletion in patients after thyroidectomy. Ann Surg Oncol 18:1293–1299
Docimo G, Tolone S, Pasquali D et al (2012) Role of pre and post-operative oral calcium and vitamin D supplements in prevention of hypocalcemia after total thyroidectomy Il. G Chir 33:374–378
Delbridge L (2012) Selective rather than routine: using sound clinical judgment. Arch Surg (Chicago, Ill : 1960) 147:344
Raffaelli M, De Crea C, Carrozza C et al (2012) Combining early postoperative parathyroid hormone and serum calcium levels allows for an efficacious selective post-thyroidectomy supplementation treatment. World J Surg 36:1307–1313
Landry CS, Grubbs EG, Hernandez M et al (2012) Predictable criteria for selective, rather than routine, calcium supplementation following thyroidectomy. Arch Surg (Chicago, Ill: 1960) 147:338–344
Cayo AK, Yen TW, Misustin SM et al (2012) Predicting the need for calcium and calcitriol supplementation after total thyroidectomy: results of a prospective, randomized study. Surgery 152:1059–1067
Tredici P, Grosso E, Gibelli B et al (2011) Identification of patients at high risk for hypocalcemia after total thyroidectomy. Acta Otorhinolaryngol Ital: Organo Ufficiale Soc Ital Otorinolaringol Chir CervicoFac 31:144–148
Salinger EM, Moore JT (2013) Perioperative indicators of hypocalcemia in total thyroidectomy: the role of vitamin D and parathyroid hormone. Am J Surg 206:876–881, discussion 881-872
Toniato A, Boschin IM, Piotto A et al (2008) Thyroidectomy and parathyroid hormone: tracing hypocalcemia-prone patients. Am J Surg 196:285–288
Scurry WC Jr, Beus KS, Hollenbeak CS et al (2005) Perioperative parathyroid hormone assay for diagnosis and management of postthyroidectomy hypocalcemia. Laryngoscope 115:1362–1366
Hallgrimsson P, Nordenstrom E, Bergenfelz A et al (2012) Hypocalcaemia after total thyroidectomy for Graves’ disease and for benign atoxic multinodular goitre. Langenbeck’s Arch Surg / Dtsch Ges Chir 397:1133–1137
Edafe O, Antakia R, Laskar N et al (2014) Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg 101:307–320
Snyder S, Govednik C, Lairmore T et al (2013) Total thyroidectomy as primary definitive treatment for Graves’ hyperthyroidism. Am Surgeon 79:1283–1288
Kirkby-Bott J, Markogiannakis H, Skandarajah A et al (2011) Preoperative vitamin D deficiency predicts postoperative hypocalcemia after total thyroidectomy. World J Surg 35:324–330
Falcone TE Noordzij JP, Jalisi S et al (2013) Preoperative vitamin D deficiency as a predictor of post-total-thyroidectomy hypocalcemia. Otolaryngology Head Neck Surg 149:186
Acknowledgments
The authors thank Mrs. Kimberly Davies for her precious help with language.
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This study has no potential conflict of interest.
Compliance with ethical standards
This study involved human participants. Informed consent was obtained by participating patients.
Authors’ contributions
Study conception and design were by De Pasquale L, Sartori PV, Vicentini L, Beretta E, Boniardi M, Leopaldi E, Gini P, La Manna L, Cozzaglio L, Steffano GB, Ghilardi G, and Morenghi E. Acquisition of data was by De Pasquale L, Sartori PV, Vicentini L, Beretta E, Boniardi M, Leopaldi E, Gini P, La Manna L, Cozzaglio L, Steffano GB, Andreani S, Badiali S, Cantoni GM, Galimberti A, Ghilardi G, Gusmeroli M, Maggiore R, Pauna J, Poggi L, and Testa V. Analysis and interpretation of data were done by Morenghi E, Sartori PV, Gusmeroli M, Maggiore R, and Testa V. Drafting of the manuscript was done by De Pasquale L, Sartori PV, and Gini P. The manuscript was critically revised by Vicentini L, Beretta E, Boniardi M, Leopaldi E, and Ghilardi G.
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De Pasquale, L., Sartori, P.V., Vicentini, L. et al. Necessity of therapy for post-thyroidectomy hypocalcaemia: a multi-centre experience. Langenbecks Arch Surg 400, 319–324 (2015). https://doi.org/10.1007/s00423-015-1292-0
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DOI: https://doi.org/10.1007/s00423-015-1292-0