Document Detail


Predicting the need for calcium and calcitriol supplementation after total thyroidectomy: results of a prospective, randomized study.
MedLine Citation:
PMID:  23068088     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The optimal protocol for the detection and treatment of postthyroidectomy hypoparathyroidism is unknown. We sought to identify and treat patients at risk for symptomatic hypocalcemia on the basis of a single parathyroid hormone (PTH) obtained the morning after surgery (POD1).
METHODS: We performed a prospective, randomized study of total thyroidectomy patients who had POD1 calcium and PTH (pg/mL) levels. Randomization was determined by POD1 PTH: if ≥ 10, patients received no supplementation unless symptomatic; if <10, patients were randomized to calcium, calcium and calcitriol, or no supplementation.
RESULTS: Of 143 patients, 112 (78%) had a POD1 PTH ≥ 10. Hypocalcemic symptoms were transiently reported in 11 (10%) and managed with outpatient calcium. Of 31 patients with PTH <10, 15 (48%) developed symptoms, including 5 who required intravenous calcium. On multivariate logistic regression analysis, when we adjusted for postoperative calcium level and performance of central neck dissection, we found that predictors of hypocalcemic symptoms were younger age (odds ratio 1.59, 95% confidence interval 1.07-2.32) and a PTH <10 (odds ratio 1.08, 95% confidence interval 1.04-1.12). There were no patient or treatment-related factors that predicted a POD1 PTH <10.
CONCLUSION: A single POD1 PTH level <10 can accurately identify those patients at risk for clinically significant hypocalcemia. All total thyroidectomy patients with a postoperative PTH ≥ 10 can be safely discharged without supplementation. Given the small number of patients with PTH <10, it is unclear whether both calcium and calcitriol are needed for these higher-risk patients.
Authors:
Ashley K Cayo; Tina W F Yen; Sarah M Misustin; Kimberly Wall; Stuart D Wilson; Douglas B Evans; Tracy S Wang
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2012-10-13
Journal Detail:
Title:  Surgery     Volume:  152     ISSN:  1532-7361     ISO Abbreviation:  Surgery     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-19     Completed Date:  2013-01-22     Revised Date:  2013-07-11    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1059-67     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Mosby, Inc. All rights reserved.
Affiliation:
Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Calcitriol / therapeutic use*
Calcium / blood,  therapeutic use*
Female
Humans
Hypocalcemia / blood,  diagnosis,  drug therapy*,  etiology*
Hypoparathyroidism / blood,  diagnosis,  drug therapy*,  etiology*
Male
Middle Aged
Parathyroid Hormone / blood
Thyroid Neoplasms / surgery
Thyroidectomy / adverse effects*
Vitamin D / analogs & derivatives,  blood,  therapeutic use
Young Adult
Grant Support
ID/Acronym/Agency:
1UL1RR031973/RR/NCRR NIH HHS; UL1 RR031973/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Parathyroid Hormone; 1406-16-2/Vitamin D; 32222-06-3/Calcitriol; 64719-49-9/25-hydroxyvitamin D; 7440-70-2/Calcium

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


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