Significance of Parathyroid Hormone Measurement after Total Thyroidectomy in Predicting Symptomatic Hypocalcemia_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Huiyuan , WANG Xiaohui , LI Fei , LUO Bin

Department of General Surgery， Xuanwu Hospital of Capital Medical University， Beijing 100053， China;

Corresponding author：

Keywords：

Thyroidectomy; Parathyroid hormone; Hypocalcemia

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Objective 　To investigate the threshold value for postoperative parathyroid hormone （PTH） that can predict the development of symptomatic hypocalcemia.
Methods 　The patients received total thyroidectomy and all the operations performed by the same team from June 2010 to December 2011 in the thyroid and breast group of department of general surgery，Xuanwu Hospital of Capital Medical University were enrolled in this prospective study. Serum PTH and calcium were tested at 1-hour postoperatively and thereafter every day during hospitalization. Symptoms of hypocalcemia were recorded. Receiver operator characteristic curve was plotted to test the value of PTH assay to predict symptomatic hypocalcemia.
Results 　There were 45 consecutive patients recruited in this prospective study，9 （20.0%） patients remained normocalcemic and 36 （80.0%） patients developed hypocalcemia postoperatively. There were 19 （42.2%） patients who developed symptoms associated with hypocalcemia and needed calcium supplement. The postoperative PTHs for normocalcemic （n=9），asymptomatic （n=17），and symptomatic （n=19） hypocalcemia patients groups were （40.5±23.7） ng/L，（18.3±9.1） ng/L，and （7.6±4.2） ng/L，respectively （P＜0.001）. The PTH value less than 13.4 ng/L could easily predict who were at high risk to develop symptomatic hypocalcemia with sensitivity of 94.7% and specificity of 76.9%.
Conclusions 　This study suggests that a 1-hour postoperative PTH level at 13.4 ng/L can identify those individuals at risk for developing symptomatic hypocalcemia. Therefore，we recommend early calcium supplementation for these patients to decrease their postoperative morbidity from symptomatic hypocalcemia.

Citation： WANG Huiyuan,WANG Xiaohui,LI Fei,LUO Bin,.. Significance of Parathyroid Hormone Measurement after Total Thyroidectomy in Predicting Symptomatic Hypocalcemia. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(8): 856-859. doi: Copy

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4.	Sosa JA， Udelsman R. Total thyroidectomy for differentiated thyroid cancer[J]. J Surg Oncol， 2006， 94(8)：701-707.
5.	Lim JP， Irvine R， Bugis S， et al. Intact parathyroid hormone measurement 1 hour after thyroid surgery identifies individuals at high risk for the development of symptomatic hypocalcemia[J]. Am J Surg， 2009， 197(5)：648-653.
6.	Lang BH， Yih PC， Ng KK. A prospective evaluation of quick intraoperative parathyroid hormone assay at the time of skin closure in predicting clinically relevant hypocalcemia after thyroidectomy[J]. World J Surg， 2012， 36(6)：1300-1306.
7.	Raffaelli M， De Crea C， Carrozza C， et al. Combining early postoperative parathyroid hormone and serum calcium levels allows for an efficacious selective post-thyroidectomy supplementation treatment[J]. World J Surg， 2012， 36(6)：1307-1313.
8.	程若川，艾杨卿，刁畅，等. 甲状腺手术中甲状旁腺显露及功能保护的临床研究[J]. 中国普外基础与临床杂志， 2009， 16(5)：351-355.
9.	Athanasopoulos PG， Kyriazi M， Arkadopoulos N， et al. Parathyroid autotransplantation in extensive head and neck resections：case series report[J]. World J Surg Oncol， 2011， 9：149.
10.	Landry CS， Grubbs EG， Hernandez M， et al. Predictable criteria for selective， rather than routine， calcium supplementation following thyroidectomy[J]. Arch Surg， 2012， 147(4)：338-344.
11.	Chapman DB， French CC， Leng X， et al. Parathyroid hormone early percent change：an individualized approach to predict postthyroidectomy hypocalcemia[J]. Am J Otolaryngol， 2012， 33(2)：216-220.
12.	Scurry WC Jr， Beus KS， Hollenbeak CS， et al. Perioperative parathyroid hormone assay for diagnosis and management of postthyroidectomy hypocalcemia[J]. Laryngoscope， 2005， 115(8)：1362-1366.
13.	Noordzij JP， Lee SL， Bernet VJ， et al. Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone：an analysis of pooled individual patient data from nine observational studies[J]. J Am Coll Surg， 2007， 205(6)：748-754.
14.	Barczyński M， Cichoń S， Konturek A. Which criterion of intraoperative iPTH assay is the most accurate in prediction of true serum calcium levels after thyroid surgery?[J]. Langenbecks Arch Surg， 2007， 392(6)：693-698.
15.	Chia SH， Weisman RA， Tieu D， et al. Prospective study of perioperative factors predicting hypocalcemia after thyroid and parathyroid surgery[J]. Arch Otolaryngol Head Neck Surg， 2006， 132(1)：41-45.
16.	Sitges-Serra A， Ruiz S， Girvent M， et al. Outcome of protracted hypoparathyroidism after total thyroidectomy[J]. Br J Surg， 2010， 97(11)：1687-1695.
17.	Lam A， Kerr PD. Parathyroid hormone：an early predictor of postthyroidectomy hypocalcemia[J]. Laryngoscope， 2003， 113(12)：2196-2200.
18.	Lecerf P， Orry D， Perrodeau E， et al. Parathyroid hormone decline 4 hours after total thyroidectomy accurately predicts hypocalcemia[J]. Surgery， 2012 May 30. [Epub ahead of print].
19.	Huang SM. Do we overtreat post-thyroidectomy hypocalcemia?[J]. World J Surg， 2012， 36(7)：1503-1508.
20.	王公明. 甲状腺围手术期血清甲状旁腺素的变化及其与甲状腺术后低钙血症的关系研究[J]. 中国全科医学杂志， 2011， 14(13)：1449-1450.
21.	de Andrade Sousa A， Salles JM， Soares JM， et al. Course of ionized calcium after thyroidectomy[J]. World J Surg， 2010， 34(5)：987-992.
22.	Hughes OR， Scott-Coombes DM. Hypocalcaemia following thyroidectomy for treatment of Graves’ disease：implications for patient management and cost-effectiveness[J]. J Laryngol Otol， 2011， 125(8)：849-852.
23.	Anastasiou OE， Yavropoulou MP， Papavramidis TS， et al. Secretory capacity of the parathyroid glands after total thyroidectomy in normocalcemic subjects[J]. J Clin Endocrinol Metab. 2012 Apr 17. [Epub ahead of print].
24.	Promberger R， Ott J， Kober F， et al. Normal parathyroid hormone levels do not exclude permanent hypoparathyroidism after thyroidectomy[J]. Thyroid， 2011， 21(2)：145-150.
25.	Prichard RS， Edhouse PJ， Sidhu SB， et al. Post-operative partial hypoparathyroidism：an under-recognized disorder[J]. ANZ J Surg， 2011， 81(7-8)：524-527.

1. Tezelman S， Borucu I， Senyurek Giles Y， et al. The change in surgical practice from subtotal to near-total or total thyroidectomy in the treatment of patients with benign multinodular goiter[J]. World J Surg， 2009， 33(3)：400-405.
2. 孙团起，吴毅. 甲状腺结节手术适应证和术式选择[J]. 中国普外基础与临床杂志， 2011， 18(8)：803-805.
3. Efremidou EI， Papageorgiou MS， Liratzopoulos N， et al. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease：a review of 932 cases[J]. Can J Surg， 2009， 52(1)：39-44.
4. Sosa JA， Udelsman R. Total thyroidectomy for differentiated thyroid cancer[J]. J Surg Oncol， 2006， 94(8)：701-707.
5. Lim JP， Irvine R， Bugis S， et al. Intact parathyroid hormone measurement 1 hour after thyroid surgery identifies individuals at high risk for the development of symptomatic hypocalcemia[J]. Am J Surg， 2009， 197(5)：648-653.
6. Lang BH， Yih PC， Ng KK. A prospective evaluation of quick intraoperative parathyroid hormone assay at the time of skin closure in predicting clinically relevant hypocalcemia after thyroidectomy[J]. World J Surg， 2012， 36(6)：1300-1306.
7. Raffaelli M， De Crea C， Carrozza C， et al. Combining early postoperative parathyroid hormone and serum calcium levels allows for an efficacious selective post-thyroidectomy supplementation treatment[J]. World J Surg， 2012， 36(6)：1307-1313.
8. 程若川，艾杨卿，刁畅，等. 甲状腺手术中甲状旁腺显露及功能保护的临床研究[J]. 中国普外基础与临床杂志， 2009， 16(5)：351-355.
9. Athanasopoulos PG， Kyriazi M， Arkadopoulos N， et al. Parathyroid autotransplantation in extensive head and neck resections：case series report[J]. World J Surg Oncol， 2011， 9：149.
10. Landry CS， Grubbs EG， Hernandez M， et al. Predictable criteria for selective， rather than routine， calcium supplementation following thyroidectomy[J]. Arch Surg， 2012， 147(4)：338-344.
11. Chapman DB， French CC， Leng X， et al. Parathyroid hormone early percent change：an individualized approach to predict postthyroidectomy hypocalcemia[J]. Am J Otolaryngol， 2012， 33(2)：216-220.
12. Scurry WC Jr， Beus KS， Hollenbeak CS， et al. Perioperative parathyroid hormone assay for diagnosis and management of postthyroidectomy hypocalcemia[J]. Laryngoscope， 2005， 115(8)：1362-1366.
13. Noordzij JP， Lee SL， Bernet VJ， et al. Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone：an analysis of pooled individual patient data from nine observational studies[J]. J Am Coll Surg， 2007， 205(6)：748-754.
14. Barczyński M， Cichoń S， Konturek A. Which criterion of intraoperative iPTH assay is the most accurate in prediction of true serum calcium levels after thyroid surgery?[J]. Langenbecks Arch Surg， 2007， 392(6)：693-698.
15. Chia SH， Weisman RA， Tieu D， et al. Prospective study of perioperative factors predicting hypocalcemia after thyroid and parathyroid surgery[J]. Arch Otolaryngol Head Neck Surg， 2006， 132(1)：41-45.
16. Sitges-Serra A， Ruiz S， Girvent M， et al. Outcome of protracted hypoparathyroidism after total thyroidectomy[J]. Br J Surg， 2010， 97(11)：1687-1695.
17. Lam A， Kerr PD. Parathyroid hormone：an early predictor of postthyroidectomy hypocalcemia[J]. Laryngoscope， 2003， 113(12)：2196-2200.
18. Lecerf P， Orry D， Perrodeau E， et al. Parathyroid hormone decline 4 hours after total thyroidectomy accurately predicts hypocalcemia[J]. Surgery， 2012 May 30. [Epub ahead of print].
19. Huang SM. Do we overtreat post-thyroidectomy hypocalcemia?[J]. World J Surg， 2012， 36(7)：1503-1508.
20. 王公明. 甲状腺围手术期血清甲状旁腺素的变化及其与甲状腺术后低钙血症的关系研究[J]. 中国全科医学杂志， 2011， 14(13)：1449-1450.
21. de Andrade Sousa A， Salles JM， Soares JM， et al. Course of ionized calcium after thyroidectomy[J]. World J Surg， 2010， 34(5)：987-992.
22. Hughes OR， Scott-Coombes DM. Hypocalcaemia following thyroidectomy for treatment of Graves’ disease：implications for patient management and cost-effectiveness[J]. J Laryngol Otol， 2011， 125(8)：849-852.
23. Anastasiou OE， Yavropoulou MP， Papavramidis TS， et al. Secretory capacity of the parathyroid glands after total thyroidectomy in normocalcemic subjects[J]. J Clin Endocrinol Metab. 2012 Apr 17. [Epub ahead of print].
24. Promberger R， Ott J， Kober F， et al. Normal parathyroid hormone levels do not exclude permanent hypoparathyroidism after thyroidectomy[J]. Thyroid， 2011， 21(2)：145-150.
25. Prichard RS， Edhouse PJ， Sidhu SB， et al. Post-operative partial hypoparathyroidism：an under-recognized disorder[J]. ANZ J Surg， 2011， 81(7-8)：524-527.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Significance of Parathyroid Hormone Measurement after Total Thyroidectomy in Predicting Symptomatic Hypocalcemia

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