Identifying early postoperative serum parathyroid hormone levels as predictors of hypocalcaemia after total thyroidectomy: A prospective non- randomized study
| Autor: | Andro Košec, Davor Vagić, Filip Matovinović, Filip Hergešić, Vladimir Bedeković, Ivan Rašić |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Time Factors Substances medicine.medical_treatment Postoperative Complications / etiology calcium hypocalcemia parathyroid hormone postoperative complications predictive value of tests ROC curve thyroidectomy Hypocalcemia / diagnosis Parathyroid hormone Thyroidectomy / methods law.invention Postoperative Complications 0302 clinical medicine Calcium / blood Randomized controlled trial law Risk Factors Hypocalcaemia Prospective Studies 030223 otorhinolaryngology Prospective cohort study Aged 80 and over Postoperative Complications / diagnosis Age Factors Middle Aged Treatment Outcome Parathyroid Hormone 030220 oncology & carcinogenesis Predictive value of tests Thyroidectomy Neck Dissection Female hormones hormone substitutes and hormone antagonists Adult medicine.medical_specialty endocrine system Urology 03 medical and health sciences Parathyroid Hormone / blood Young Adult Predictive Value of Tests medicine Biomarkers / blood Humans Hypocalcemia / etiology Aged Hypocalcemia business.industry Neck dissection medicine.disease Otorhinolaryngology Concomitant Calcium business Biomarkers |
| Popis: | Objective: There is no clear cut-off value of serum parathyroid hormone (PTH) or calcium in which patients are at risk for hypocalcemia after total thyroidectomy. We evaluated the usefulness of serum calcium and PTH concentration measurements after total thyroidectomy in predicting late-occurring hypocalcemia. ----- Design: A prospective, single-center, non-randomized longitudinal cohort study of 143 patients undergoing thyroidectomy between August 2019 and December 2019 with serum calcium and PTH levels sampled 1 h after surgery and on the first and fifth postoperative day. Hypocalcemia was defined as serum calcium levels < 2.14 mmol/L regardless of clinical symptoms. Normal PTH range was 1.6-6.9 pmol/L. ----- Measurements: The primary outcome measure was presence of hypocalcemia on the first and fifth postoperative day, analyzed by a logistic regression model. The PTH cut-off value for prediction of hypocalcemia was identified using a ROC curve comparing all three time points using the Youden J index. ----- Results: Out of 143 patients, 52 (36.4%) had hypocalcemia on the fifth postoperative day. Advanced age, concomitant neck dissection and serum PTH levels < 2.9 pmol/L 1 h after surgery and on the first postoperative surgery day were associated with a high risk of hypocalcemia on the first and fifth postoperative day and need for higher doses of calcium supplements (P < 0.0001, AUC 0.748, 95% CI 0.669-0.817, with 76.92% sensitivity and 71.43% specificity). ----- Conclusion: Serum PTH level measured immediately postoperatively and on the first postoperative day is a reliable predictor of postoperative hypocalcemia with important clinical implications. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|