Intraoperative parathyroid hormone assay: An accurate predictor of symptomatic hypocalcemia following thyroidectomy

Melanie L. Richards, Juliane Bingener-Casey, Damon Pierce, William E. Strodel, Kenneth R. Sirinek, Jon Van Heerden, Richard A. Prinz, Peter Angelos

Research output: Contribution to journalArticle

106 Scopus citations

Abstract

Hypothesis: Intraoperative parathyroid hormone (IOPTH) assay is useful for predicting symptomatic hypocalcemia following total thyroidectomy. Design: A prospective study of 30 patients undergoing total thyroidectomy with IOPTH levels obtained following skin closure and ionized calcium (Ca2+) levels obtained 6 hours postoperatively and on postoperative day 1. All patients were evaluated for symptoms of hypocalcemia. Setting: University teaching hospital. Main Outcome Measures: Patients who developed symptomatic hypocalcemia were compared with asymptomatic patients in regard to age, diagnosis, thyroid weight, thyrotropin level, Ca2+ level, parathyroid status, and IOPTH level. Results: The onset of symptomatic hypocalcemia ranged from 8 to 48 hours postoperatively (n = 10). One patient required readmission. Of 10 patients with symptoms, 5 developed tetany. There were no significant differences in age, diagnosis, thyroid weight, thyrotropin level, or the number of parathyroid glands preserved in patients with or without symptomatic hypocalcemia. All patients with an IOPTH level of less than 10 pg/mL (1.1 pmol/L) had symptoms (n=8). The mean±SD IOPTH level (7.6±12.0 pg/mL [0.8±1.3 pmol/L]) in patients who developed symptomatic hypocalcemia was significantly lower than the mean IOPTH level (55.7±31.8 pg/mL [5.9±3.3 pmol/L]) in patients without symptoms (P=.001). The 6-hour and postoperative day 1 Ca2+ levels were significantly lower in patients with symptomatic hypocalcemia (P=.19 and P=.13, respectively). An IOPTH level of less than 10 pg/mL is 80% sensitive and 100% specific for the development of symptomatic hypocalcemia. Conclusion: The incorporation of the IOPTH assay in the management of thyroid disease is recommended to prevent and prospectively treat symptomatic hypocalcemia, thereby reducing readmissions following thyroidectomy.

Original languageEnglish (US)
Pages (from-to)632-636
Number of pages5
JournalArchives of Surgery
Volume138
Issue number6
DOIs
StatePublished - Jun 1 2003

ASJC Scopus subject areas

  • Surgery

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    Richards, M. L., Bingener-Casey, J., Pierce, D., Strodel, W. E., Sirinek, K. R., Van Heerden, J., Prinz, R. A., & Angelos, P. (2003). Intraoperative parathyroid hormone assay: An accurate predictor of symptomatic hypocalcemia following thyroidectomy. Archives of Surgery, 138(6), 632-636. https://doi.org/10.1001/archsurg.138.6.632