A postoperative parathyroid hormone-based algorithm to reduce symptomatic hypocalcemia following completion/total thyroidectomy: A retrospective analysis of 591 patients
| Autor: | Ying Liu, Tracy S. Wang, Azadeh A. Carr, Ioanna G. Mazotas, Jiyoon Park, Tina W.F. Yen, Douglas B. Evans, Daniel Eastwood |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Calcitriol Calcium-Regulating Hormones and Agents Urology Parathyroid hormone 030230 surgery 03 medical and health sciences 0302 clinical medicine Calcium supplementation Postoperative Complications medicine Retrospective analysis Humans Retrospective Studies Total thyroidectomy Hypocalcemia business.industry Retrospective cohort study Middle Aged Parathyroid hormone level Parathyroid Hormone 030220 oncology & carcinogenesis Thyroidectomy Surgery Calcium Female business hormones hormone substitutes and hormone antagonists Algorithms Needs Assessment medicine.drug |
| Zdroj: | Surgery. 164(4) |
| ISSN: | 1532-7361 |
| Popis: | An institutional protocol for selective calcium/calcitriol supplementation after completion/total thyroidectomy was established based on the 4-hour postoperative parathyroid hormone level. The aim of this study was to evaluate the outcomes of this protocol 5 years after implementation.All patients who underwent completion/total thyroidectomy from January 2012 to December 2016 were reviewed. Predictors of a 4-hour parathyroid hormone level10 pg/mL and symptomatic hypocalcemia were assessed.Of 591 patients, 448 (76%) had a 4-hour parathyroid hormone ≥10, 72 (12%) had a 4-hour parathyroid hormone of 5-10, and 71 (12%) had a 4-hour parathyroid hormone5. Hypocalcemic symptoms were infrequent (30/448, 7%) if the 4-hour parathyroid hormone was ≥10; 56% (40/71) of those with a 4-hour parathyroid hormone5 reported symptoms. With 4-hour parathyroid hormone of 5-10, symptoms were reported in 32 of 72 (44%) patients; supplementation at discharge included calcium (n = 55, 76%), calcium and calcitriol (n = 12, 17%), or none (n = 5, 7%). Ten patients subsequently received calcitriol for persistent symptoms. On multivariate analysis, predictors of 4-hour parathyroid hormone10 included incidental parathyroidectomy, malignancy, and thyroiditis; predictors of hypocalcemic symptoms included age55 and 4-hour parathyroid hormone10.After completion/total thyroidectomy, patients with a 4-hour parathyroid hormone ≥10 can be safely discharged without routine supplementation. The addition of calcitriol to calcium supplementation should be strongly considered for patients with a 4-hour parathyroid hormone of 5-10. |
| Databáze: | OpenAIRE |
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