Elsevier

Surgery

Volume 157, Issue 2, February 2015, Pages 349-353
Surgery

Endocrine
Postoperative hypoparathyroidism after thyroidectomy: Efficient and cost-effective diagnosis and treatment

https://doi.org/10.1016/j.surg.2014.09.007Get rights and content

Background

To describe a standardized, efficient, and cost-effective protocol for the diagnosis of temporary/persisting postoperative hypoparathyroidism after (total) thyroidectomy.

Methods

We included 237 consecutive patients who underwent (total) thyroidectomy without central neck dissection for various indications. Serum calcium (sCa) and intact parathyroid hormone (iPTH) levels were measured prospectively on the morning of postoperative day 1 to predict the long-term parathyroid metabolism. On the morning of postoperative day 2, measurements were repeated. Follow-up was performed at 1 and 6 months postoperatively.

Results

On the morning of postoperative day 1, patients with iPTH ≥ 15 pg/mL (178/237; 75%) and sCa > 2.0 mmol/L were normocalcemic, and “normal” parathyroid metabolism was predicted. iPTH levels of <10 pg/mL and sCa levels of ≤2.0 mmol/L were present in 33 of the 237 patients (“disturbed” parathyroid metabolism; 14%). A “gray zone” included patients with “uncertain” parathyroid metabolism demonstrating iPTH levels between 10 and 15 pg/mL (26/237; 11%). Patients with “disturbed” and “uncertain” parathyroid metabolism were given oral calcium and vitamin D. On the morning of the second postoperative day, iPTH turned to “normal” in 10 of those 26 (38%) patients, and no further calcium or vitamin D was given. During follow-up, supplemental calcium and vitamin D was able to be stopped in all but 2 patients (“permanent” hypoparathyroidism; 2/237; 0.8%).

Conclusion

Measurement of iPTH on the morning after operation allows accurate prediction of postoperative parathyroid function in ≥99% of cases. This simple recommendation is practicable in all surgical units, and is an efficient and cost-effective way to recognize patients who require calcium and vitamin D supplementation.

Section snippets

Methods

Over a period of 3 years, patients with benign disease of the thyroid gland were followed prospectively after (total) thyroidectomy without lymphadenectomy (central [level 6] neck dissection) but with extended dissection of both inferior (recurrent) laryngeal nerves. Thyroidectomy was performed in a tertiary referral university hospital by experienced endocrine surgeons. Informed consent was obtained from all patients.

Results

We included 237 consecutive patients (191 female, 46 male; mean age 53.7 years; range 16–87) with normal thyroid metabolism but with bilateral thyroid nodules who underwent (total) thyroidectomy without central neck dissection but with extended dissection of both inferior (recurrent) laryngeal nerves. Histology revealed benign goiter in all patients. Based on results from a prior study,21 parathyroid hormone metabolism was evaluated on the morning of postoperative day 1 (12–24 hours

Discussion

Postoperative hypocalcemia caused by temporarily “disturbed” parathyroid metabolism is a clinically relevant complication that can occur after thyroid operation. Temporary and permanent postoperative hypoparathyroidism have been described with a prevalence of 1.6–53.6% and 0.2–9.3%, respectively.3, 4, 5 Permanent hypoparathyroidism was documented in 0.8% of our patients after (total) thyroidectomy.

There are several reasons for decreased sCa after total thyroidectomy. Hemodilution during any

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    Disclosure statement: The authors have nothing to declare.

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