The role and timing of parathyroid hormone determination after total thyroidectomy
| Autor: | Ioanna G. Mazotas, Tracy S. Wang |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Completion thyroidectomy
endocrine system Calcitriol business.industry medicine.medical_treatment Thyroidectomy nutritional and metabolic diseases Parathyroid hormone Review Article Perioperative 030230 surgery Lower risk medicine.disease 03 medical and health sciences 0302 clinical medicine Hypoparathyroidism 030220 oncology & carcinogenesis Anesthesia Medicine Surgery business Complication hormones hormone substitutes and hormone antagonists medicine.drug |
| Zdroj: | Gland Surgery. 6:S38-S48 |
| ISSN: | 2227-8575 2227-684X |
| DOI: | 10.21037/gs.2017.09.06 |
| Popis: | Postoperative hypocalcemia is a common complication of total thyroidectomy resulting from manipulation, resection, or devascularization of the parathyroid glands. Parathyroid hormone (PTH) levels assessed in the perioperative period have been used to predict development of hypocalcemia. Articles examining the role of PTH measurement in the perioperative period following total or completion thyroidectomy are reviewed. Focus is placed on the timing of PTH measurement and the ability to predict which patients will develop hypocalcemia requiring supplementation. Postoperative PTH determination is highly accurate in predicting the development of hypocalcemia. Studies have examined PTH levels drawn at differing time points, ranging from intraoperatively until postoperative day 1 (POD1) with similar accuracy. This data is used to guide postoperative selective calcium and calcitriol supplementation in patients at highest risk for hypocalcemia. When evaluated within the first 4 hours postoperatively, predictive accuracy is maintained but can allow for earlier discharge for those patients at lower risk. Alternatively, some authors argue for routine supplementation, which can reduce the rate of postoperative hypocalcemia but increases the rate of unnecessary supplementation and potential risks associated with hypercalcemia. PTH determination at four hours after total thyroidectomy is an accurate predictor of hypocalcemia and can guide selective calcium supplementation for those at high risk, as well as facilitate a safe earlier hospital discharge for those at low risk of developing postoperative hypocalcemia. |
| Databáze: | OpenAIRE |
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