Document Detail

Hypocalcaemia and parathyroid hormone assay following total thyroidectomy: predicting the future.
MedLine Citation:
PMID:  16680597     Owner:  NLM     Status:  MEDLINE    
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.
C Wong; S Price; D Scott-Coombes
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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    
Department of Surgery, Frenchay Hospital, Frenchay Park, Bristol, BS16 1LE, UK.
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MeSH Terms
Ambulatory Surgical Procedures
Hypocalcemia / blood,  diagnosis*,  etiology*
Middle Aged
Parathyroid Hormone / blood
Prospective Studies
Thyroid Diseases / surgery*
Thyroidectomy / adverse effects*
Reg. No./Substance:
0/Parathyroid Hormone
Comment In:
World J Surg. 2007 Aug;31(8):1718-9   [PMID:  17534539 ]

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