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Early Detection of Hypocalcemia After Total/Completion Thyroidectomy: Routinely Usable Algorithm Based on Serum Calcium Level.
MedLine Citation:
PMID:  22855216     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The purpose of this prospective bicentric study was to investigate the course of serum calcium (Ca) and phosphorus (Phph) after total/completion thyroidectomy to establish a reliable and cost-effective strategic algorithm to detect patients at risk for postoperative hypocalcemia. METHODS: This observational study included 136 patients. Serum Ca and Phph levels were preoperatively and postoperatively recorded 6, 12, 20, and 48 h (H) after skin closure. Criteria for hypocalcemia were postoperative Ca levels ≤1.9 mmol/L at any time point and/or patients experiencing symptoms of hypocalcemia. Postoperative Ca supplementation was never given before H20 assay. Ca levels and their differences between time points were compared. RESULTS: Twenty-four percent of patients experienced hypocalcemia. At H12 and H20, the rates of patients with Ca levels ≤1.9 mmol/L were similar and larger than at H6 (p < 0.001). The H20-preoperative difference had the best area under the ROC curves (value = 0.87), and a difference ≤-0.3 was significantly more frequent in case of hypocalcemia (p = 0.001). The H20 assay and the difference H20-preop were consequently selected to design a new algorithm for hypocalcemia detection. Adding H48 assay in some specific cases (12.5 % of all included patients) enabled 100 % detection. Phosphorus assays were not informative in detecting hypocalcemia. CONCLUSIONS: This new algorithm enables, with 100 % sensitivity and 88.4 % specificity, early detection of severe hypocalcemia after total/completion thyroidectomy. It may become a useful and cost-effective tool for safe and early patient discharge, especially if PTH assays cannot be routinely used because of their availability or cost.
Authors:
Diane S Lazard; Gaëlle Godiris-Petit; Isabelle Wagner; Emile Sarfati; Frédéric Chabolle
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-2
Journal Detail:
Title:  World journal of surgery     Volume:  -     ISSN:  1432-2323     ISO Abbreviation:  World J Surg     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-2     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of General, Digestive and Endocrine Surgery, Hôpital de la Pitié-Salpêtrière, AP-HP, University of Paris 6, 47 boulevard de l'Hôpital, 75013, Paris, France, dianelazard@yahoo.fr.
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