Document Detail


Hypocalcaemia and parathyroid hormone assay following total thyroidectomy: predicting the future.
MedLine Citation:
PMID:  16680597     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Ambulatory surgery (23:59-hour hospital stay) is gaining popularity in endocrine surgery. Hypocalcaemia is common following total thyroidectomy. Identifying patients with low risk of hypocalcaemia may facilitate early discharge (24-hour stay). METHODS: We conducted a prospective study including all patients undergoing total thyroidectomy. Blood samples were taken immediately following skin closure and the following morning for parathyroid hormone (PTH) and calcium measurement. Calcium supplements were routinely given when serum calcium was below 2.0 mmol/l. RESULTS: Thirty patients (27 females, 3 males) underwent total thyroidectomy (including 4 nodal dissection) for multinodular goitre (14), Graves' disease (11), papillary (4) and follicular (1) thyroid carcinoma. Twelve patients developed symptomatic transient hypocalcaemia. Based on morning calcium of < 2.0 mmol/l as trigger for calcium supplementation, 8 patients received calcium supplement with 4 false negatives, resulting in a specificity of 94.4%, sensitivity of 66.7%, positive predictive value (PPV) of 88.9% and negative predictive value (NPV) of 81%. Based on PTH levels (< 1.5 pmol/l) immediately following skin closure, 11 patients would receive calcium supplement, with 1 false negative resulting in a specificity of 83.3%, sensitivity of 91.7%, PPV of 78.6% and NPV of 93.8%. If supplementation is based on PTH levels (< 1.5 pmol/l) immediately following skin closure and morning calcium level (< 2.0 mmol/l), all 12 symptomatic patients will be correctly treated, with 4 false positives resulting in a combined specificity of 77.8%, sensitivity of 100%, PPV of 75% and NPV of 100%. CONCLUSIONS: Combining the immediate postoperation PTH levels (< 1.5 pmol/l) and morning serum calcium (< 2.0 mmol/l) can accurately identify patients at risk of hypocalcaemia following total thyroidectomy, allowing safe, early discharge.
Authors:
C Wong; S Price; D Scott-Coombes
Related Documents :
8256207 - Surgical and medical management of patients with pulmonary metastasis from parathyroid ...
11045317 - Vitamin b6 deficiency in elderly patients on chronic peritoneal dialysis.
2746157 - Experimental and immunohistochemical studies on the possible role of parathyroid hormon...
17496397 - The influence of serum 25-hydroxy vitamin d levels on helicobacter pylori infections in...
7950337 - Fleck dystrophy of the cornea; a report of cases from three generations of a family.
22119537 - Oxidized high-density lipoprotein as a risk factor for cardiovascular events in prevale...
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  World journal of surgery     Volume:  30     ISSN:  0364-2313     ISO Abbreviation:  World J Surg     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-05-08     Completed Date:  2006-10-19     Revised Date:  2008-01-15    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  825-32     Citation Subset:  IM    
Affiliation:
Department of Surgery, Frenchay Hospital, Frenchay Park, Bristol, BS16 1LE, UK.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Ambulatory Surgical Procedures
Female
Humans
Hypocalcemia / blood,  diagnosis*,  etiology*
Male
Middle Aged
Parathyroid Hormone / blood
Prospective Studies
Thyroid Diseases / surgery*
Thyroidectomy / adverse effects*
Chemical
Reg. No./Substance:
0/Parathyroid Hormone
Comments/Corrections
Comment In:
World J Surg. 2007 Aug;31(8):1718-9   [PMID:  17534539 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Pitfalls of intraoperative neuromonitoring for predicting postoperative recurrent laryngeal nerve fu...
Next Document:  Sentinel lymph node biopsy may be used to support the decision to perform modified radical neck diss...