Predicting hypocalcemia after thyroidectomy in children
| Autor: | María Gabriela Ropelato, María Gabriela Ballerini, Laura Gruñeiro de Papendieck, Ana Chiesa, Analia Freire, Oscar Acha, Ignacio Bergadá |
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| Rok vydání: | 2013 |
| Předmět: |
Male
endocrine system medicine.medical_specialty Adolescent Hypoparathyroidism medicine.medical_treatment Urology Risk Assessment Sensitivity and Specificity Decision Support Techniques Intraoperative Period Postoperative Complications Predictive Value of Tests Outcome Assessment Health Care Medicine Postoperative outcome Humans In patient Postoperative Period Prospective Studies Prospective cohort study Child Total thyroidectomy Hypocalcemia business.industry Thyroid Thyroidectomy Surgery Clinical trial medicine.anatomical_structure Parathyroid Hormone Predictive value of tests Child Preschool Calcium Female business hormones hormone substitutes and hormone antagonists Algorithms Biomarkers Follow-Up Studies |
| Zdroj: | Surgery. 156(1) |
| ISSN: | 1532-7361 |
| Popis: | Background and aims Hypocalcemia after thyroidectomy is caused by parathyroid trauma. There are no studies regarding the usefulness of intact parathyroid hormone (PTH) as a monitor of postoperative hypoparathyroidism tool in pediatrics. We evaluated the diagnostic accuracy of intra- and postoperative PTH to predict the risk of developing post thyroidectomy hypocalcemia in children. Methods A prospective longitudinal cohort study was conducted in 32 pediatric patients (3.2–17.6 years old) undergoing total thyroidectomy. Intact PTH measured by the assays (Immulite Immunoassay System [ICMA] or electrochemioluminescence assay [ECLIA]) at 5 (PTH-5) and 60 (PTH-60) minutes after thyroid removal were considered as predicting variables. The postoperative outcome was hypocalcemia (endpoint variable). Patients were clinically and biochemically monitored regularly for 48 hours after surgery. Results Of the patients, 47% developed hypocalcemia (15% symptomatic). An ICMA PTH-5 of ≤14 pg/mL or an ECLIA PTH-5 of ≤16 pg/mL predicted hypocalcemia with a sensitivity of 80%, specificity of 100%, positive predictive value (PPV) of 100%, and diagnostic efficiency (DE) of 91%. Using the same cutoff values, PTH-60 presented a sensitivity of 93%, specificity of 82%, PPV of 81%, and DE of 87%. Adjusting for variation in the assays and combining intra- and postoperative PTH determinations, we developed an algorithm that improved sensitivity, specificity, and DE. Conclusion PTH is useful for predicting hypocalcemia after total thyroidectomy in children. The use of our proposed strategy should be considered to (a) initiate preventive treatment in patients identified at high risk for hypocalcemia, (b) shorten the duration of hospitalization, and (c) reduce the clinical and biochemical controls in those who remained normocalcemic. |
| Databáze: | OpenAIRE |
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