4-Hour postoperative PTH level predicts hypocalcemia after thyroidectomy in children.

Autor: Overman RE Jr; Division of Pediatric Surgery, Department of Surgery, University of Michigan, 1540 E Hospital Dr. Rm 4972, Ann Arbor, MI 48109. Electronic address: Elliott.overman@gmail.com., Hsieh LB; Division of Pediatric Surgery, Department of Surgery, University of Michigan, 1540 E Hospital Dr. Rm 4972, Ann Arbor, MI 48109. Electronic address: Lily.hsieh@gmail.com., Menon R; Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, University of Michigan, 1500 E Medical Center Dr, D1205 MPB, Ann Arbor, MI 48109. Electronic address: rammenon@med.umich.edu., Thomas IH; Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, University of Michigan, 1500 E Medical Center Dr, D1205 MPB, Ann Arbor, MI 48109. Electronic address: inash@med.umich.edu., Bruch SW; Division of Pediatric Surgery, Department of Surgery, University of Michigan, 1540 E Hospital Dr. Rm 4972, Ann Arbor, MI 48109. Electronic address: sbruch@med.umich.edu.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2020 Jul; Vol. 55 (7), pp. 1265-1269. Date of Electronic Publication: 2019 Dec 16.
DOI: 10.1016/j.jpedsurg.2019.11.014
Abstrakt: Background: Hypocalcemia occurs frequently after a total thyroidectomy in pediatric patients. Four hour postoperative PTH monitoring predicts the need for calcium supplementation in the adult thyroidectomy population. We evaluated the role of the 4 h postoperative PTH level in determining the need for calcium supplementation after thyroidectomy in the pediatric population.
Methods: This is a retrospective review of children undergoing total thyroidectomy by a single pediatric surgeon from July 2011 through July 2018. Intact PTH obtained four hours postoperatively determined the need for calcium supplementation for patients beginning in November 2014 onward. Serum total calcium levels were monitored concurrently with serum intact PTH levels. Serum calcium levels were followed in our Multispecialty Pediatric Endocrine Surgery clinic within the month following thyroidectomy.
Results: From July 2011 through July 2018, there were a total of 56 total thyroidectomies at our institution. Prior to November 2014, all pediatric total thyroidectomies received calcium supplementation per our institutional protocol. Based on ionized calcium levels, 26.3% (5/19) of children developed hypocalcemia. From November 2014 to July 2018, 37 pediatric patients required total thyroidectomies. 29.7% (11/37) had low 4-h postoperative PTH levels. 72.7% (8/11) patients with low 4-h postoperative PTH levels had corresponding postoperative day 1 total calcium levels less than 8.5 or ionized calcium levels less than 1.12, and five children (45.5%) developed symptomatic hypocalcemia. 70% (26/37) of children had normal 4-h postop PTH levels, with only 5 (19%) ever developing hypocalcemia. No patients with a normal postop PTH level developed symptomatic hypocalcemia or required IV calcium repletion. A single 4-h postoperative PTH <10 pg/dl for identifying hypocalcemia has a sensitivity of 81% and specificity of 91%, with AUC 0.81.
Conclusion: The 4-h postoperative serum PTH level can help determine the need for calcium supplementation in pediatric patients undergoing total thyroidectomy, thereby reducing unnecessary calcium supplementation and serial lab draws to monitor for postoperative hypocalcemia.
Level of Evidence: Level II.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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