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World J Surg. 2010 Mar;34(3):532-7. doi: 10.1007/s00268-009-0348-0.

An algorithm informed by the parathyroid hormone level reduces hypocalcemic complications of thyroidectomy.

Author information

1
Endocrine Surgical Unit, Department of Surgery, University of California Los Angeles, 10833 Le Conte Avenue, 72-229 CHS, Los Angeles, CA 90095, USA. jwiseman@mednet.ucla.edu

Abstract

BACKGROUND:

Measurement of the parathyroid hormone (PTH) level following total thyroidectomy (TTx) may allow prediction of postoperative hypocalcemia. We present an algorithmic method of managing hypocalcemia pre-emptively, based on the PTH level 1 h after operation.

MATERIALS AND METHODS:

We examined 423 consecutive patients undergoing TTx at a single institution. A subset of patients were managed using an algorithm involving routine postoperative oral calcium administration and the early addition of oral calcitriol in patients with a low 1-h postoperative PTH level. Algorithm patients were compared to a concurrent, conventionally managed group. Outcomes measured included serum calcium levels, symptoms of hypocalcemia, postoperative complications, and receipt of intravenous (i.v.) calcium.

RESULTS:

The algorithm was applied in 135 patients, and 288 patients were managed conventionally. Critically low calcium levels (total calcium <7.5 mg/dl [1.88 mmol/l] or ionized calcium <0.94 mmol/l) were less common in algorithm patients (10.6% vs. 25.3%; p < 0.005). Much of this difference was attributable to the protective impact of the algorithm on patients undergoing TTx for cancer, 30% of whom developed critically low calcium levels when managed conventionally. Among patients requiring i.v. calcium, algorithm patients received fewer doses (1.29 vs. 1.86; p < 0.05). Low 1-h PTH levels were found in 21% (28/133) of algorithm patients, but these did not correlate with low calcium levels, suggesting that the algorithm compensated adequately for temporary hypoparathyroidism. No patients developed hypercalcemia.

CONCLUSIONS:

An algorithmic approach incorporating early postoperative PTH levels and routine administration of oral calcium reduces the risk of severe hypocalcemia after total thyroidectomy.

PMID:
20049440
PMCID:
PMC2816818
DOI:
10.1007/s00268-009-0348-0
[Indexed for MEDLINE]
Free PMC Article

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