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Erschienen in:
01.10.2015 | Original Article
Algorithm for early discharge after total thyroidectomy using PTH to predict hypocalcemia: prospective study
Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 7/2015
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Purpose
Hypocalcemia is the most common complication after total thyroidectomy. The aim of this study was to determine whether postoperative parathyroid hormone (PTH) levels predict hypocalcemia in order to design an algorithm for early discharge.
Methods
We present a prospective study including patients who underwent total thyroidectomy. Hypocalcemia was defined as serum ionized calcium < 1.09 mmol/L or clinical evidence of hypocalcemia. PTH measurement was performed preoperatively and at 1, 3, and 6 h postoperatively. The percent decline of preoperative values was calculated for each time point.
Results
One hundred and six patients were included. Thirty-six (33.9 %) patients presented hypocalcemia. A 50 % decline in PTH levels at 3 h postoperatively showed the highest sensitivity and specificity to predict hypocalcemia (91 and 73 %, respectively). No patients with a decrease <35 % developed hypocalcemia (100 % sensitivity), and all patients with a decrease >80 % had hypocalcemia (100 % specificity).
Conclusions
PTH determination at 3 h postoperatively is a reliable predictor of hypocalcemia. According to the proposed algorithm, patients with less than 80 % drop in PTH levels can be safely discharged the day of the surgery.