One-Hour Postoperative Parathyroid Hormone Levels Do Not Reliably Predict Hypocalcemia After Thyroidectomy

Zeyad Sahli, Alireza Najafian, Stacie Kahan, Eric B. Schneider, Martha A. Zeiger, Aarti Mathur

Research output: Contribution to journalArticle

Abstract

Introduction: Hypocalcemia is a well-known complication after total thyroidectomy. Studies have indicated that the presence of low postoperative parathyroid hormone (PTH) levels can predict hypocalcemia. However, definitive study designs are lacking. The aim of this study was to determine whether postoperative PTH alone can accurately predict postoperative biochemical hypocalcemia. Methods: Under IRB approval, a prospective study of 218 consecutive patients who underwent total or completion thyroidectomy by two surgeons between June 2014 and June 2016 was performed. Biochemical hypocalcemia was defined as ionized calcium <1.13 mmol/L or serum calcium <8.4 mg/dL at any time postoperatively. Three PTH thresholds, <10, <20 pg/mL, and >50% drop in PTH 1 h postoperatively from baseline were examined. Results: Postoperative PTH < 10 pg/mL had a sensitivity of 36.5% (95% CI 27.4–46.3%) and a specificity of 89.2% (95% CI 81.9–94.3%). Postoperative PTH < 20 pg/mL had a sensitivity of 66.4% (95% CI 56.6–75.2%) and a specificity of 67.6% (95% CI 58.0–76.2%). Postoperative PTH decrease >50% had a sensitivity of 63.4% (95% CI 53.2–72.7%) and a specificity of 72.5% (95% CI 62.5–81.0%). Across all PTH thresholds, the false-negative rate was 33.6–63.5% indicating that up to 64% of patients with a normal PTH level could have been discharged without appropriate calcium supplementation. The false-positive rate was 10.8–32.4% indicating that up to 32.4% of patients with low PTH could have been treated with calcium supplementation unnecessarily. Conclusion: Following total thyroidectomy, PTH levels are unreliable in predicting hypocalcemia. Additional prospective studies are needed to understand the true utility of PTH levels post-thyroidectomy.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalWorld Journal of Surgery
DOIs
StateAccepted/In press - Dec 31 2017

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Hypocalcemia
Thyroidectomy
Parathyroid Hormone
Calcium
Prospective Studies
Research Ethics Committees

ASJC Scopus subject areas

  • Surgery

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One-Hour Postoperative Parathyroid Hormone Levels Do Not Reliably Predict Hypocalcemia After Thyroidectomy. / Sahli, Zeyad; Najafian, Alireza; Kahan, Stacie; Schneider, Eric B.; Zeiger, Martha A.; Mathur, Aarti.

In: World Journal of Surgery, 31.12.2017, p. 1-6.

Research output: Contribution to journalArticle

Sahli, Zeyad ; Najafian, Alireza ; Kahan, Stacie ; Schneider, Eric B. ; Zeiger, Martha A. ; Mathur, Aarti. / One-Hour Postoperative Parathyroid Hormone Levels Do Not Reliably Predict Hypocalcemia After Thyroidectomy. In: World Journal of Surgery. 2017 ; pp. 1-6.
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title = "One-Hour Postoperative Parathyroid Hormone Levels Do Not Reliably Predict Hypocalcemia After Thyroidectomy",
abstract = "Introduction: Hypocalcemia is a well-known complication after total thyroidectomy. Studies have indicated that the presence of low postoperative parathyroid hormone (PTH) levels can predict hypocalcemia. However, definitive study designs are lacking. The aim of this study was to determine whether postoperative PTH alone can accurately predict postoperative biochemical hypocalcemia. Methods: Under IRB approval, a prospective study of 218 consecutive patients who underwent total or completion thyroidectomy by two surgeons between June 2014 and June 2016 was performed. Biochemical hypocalcemia was defined as ionized calcium <1.13 mmol/L or serum calcium <8.4 mg/dL at any time postoperatively. Three PTH thresholds, <10, <20 pg/mL, and >50{\%} drop in PTH 1 h postoperatively from baseline were examined. Results: Postoperative PTH < 10 pg/mL had a sensitivity of 36.5{\%} (95{\%} CI 27.4–46.3{\%}) and a specificity of 89.2{\%} (95{\%} CI 81.9–94.3{\%}). Postoperative PTH < 20 pg/mL had a sensitivity of 66.4{\%} (95{\%} CI 56.6–75.2{\%}) and a specificity of 67.6{\%} (95{\%} CI 58.0–76.2{\%}). Postoperative PTH decrease >50{\%} had a sensitivity of 63.4{\%} (95{\%} CI 53.2–72.7{\%}) and a specificity of 72.5{\%} (95{\%} CI 62.5–81.0{\%}). Across all PTH thresholds, the false-negative rate was 33.6–63.5{\%} indicating that up to 64{\%} of patients with a normal PTH level could have been discharged without appropriate calcium supplementation. The false-positive rate was 10.8–32.4{\%} indicating that up to 32.4{\%} of patients with low PTH could have been treated with calcium supplementation unnecessarily. Conclusion: Following total thyroidectomy, PTH levels are unreliable in predicting hypocalcemia. Additional prospective studies are needed to understand the true utility of PTH levels post-thyroidectomy.",
author = "Zeyad Sahli and Alireza Najafian and Stacie Kahan and Schneider, {Eric B.} and Zeiger, {Martha A.} and Aarti Mathur",
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T1 - One-Hour Postoperative Parathyroid Hormone Levels Do Not Reliably Predict Hypocalcemia After Thyroidectomy

AU - Sahli, Zeyad

AU - Najafian, Alireza

AU - Kahan, Stacie

AU - Schneider, Eric B.

AU - Zeiger, Martha A.

AU - Mathur, Aarti

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N2 - Introduction: Hypocalcemia is a well-known complication after total thyroidectomy. Studies have indicated that the presence of low postoperative parathyroid hormone (PTH) levels can predict hypocalcemia. However, definitive study designs are lacking. The aim of this study was to determine whether postoperative PTH alone can accurately predict postoperative biochemical hypocalcemia. Methods: Under IRB approval, a prospective study of 218 consecutive patients who underwent total or completion thyroidectomy by two surgeons between June 2014 and June 2016 was performed. Biochemical hypocalcemia was defined as ionized calcium <1.13 mmol/L or serum calcium <8.4 mg/dL at any time postoperatively. Three PTH thresholds, <10, <20 pg/mL, and >50% drop in PTH 1 h postoperatively from baseline were examined. Results: Postoperative PTH < 10 pg/mL had a sensitivity of 36.5% (95% CI 27.4–46.3%) and a specificity of 89.2% (95% CI 81.9–94.3%). Postoperative PTH < 20 pg/mL had a sensitivity of 66.4% (95% CI 56.6–75.2%) and a specificity of 67.6% (95% CI 58.0–76.2%). Postoperative PTH decrease >50% had a sensitivity of 63.4% (95% CI 53.2–72.7%) and a specificity of 72.5% (95% CI 62.5–81.0%). Across all PTH thresholds, the false-negative rate was 33.6–63.5% indicating that up to 64% of patients with a normal PTH level could have been discharged without appropriate calcium supplementation. The false-positive rate was 10.8–32.4% indicating that up to 32.4% of patients with low PTH could have been treated with calcium supplementation unnecessarily. Conclusion: Following total thyroidectomy, PTH levels are unreliable in predicting hypocalcemia. Additional prospective studies are needed to understand the true utility of PTH levels post-thyroidectomy.

AB - Introduction: Hypocalcemia is a well-known complication after total thyroidectomy. Studies have indicated that the presence of low postoperative parathyroid hormone (PTH) levels can predict hypocalcemia. However, definitive study designs are lacking. The aim of this study was to determine whether postoperative PTH alone can accurately predict postoperative biochemical hypocalcemia. Methods: Under IRB approval, a prospective study of 218 consecutive patients who underwent total or completion thyroidectomy by two surgeons between June 2014 and June 2016 was performed. Biochemical hypocalcemia was defined as ionized calcium <1.13 mmol/L or serum calcium <8.4 mg/dL at any time postoperatively. Three PTH thresholds, <10, <20 pg/mL, and >50% drop in PTH 1 h postoperatively from baseline were examined. Results: Postoperative PTH < 10 pg/mL had a sensitivity of 36.5% (95% CI 27.4–46.3%) and a specificity of 89.2% (95% CI 81.9–94.3%). Postoperative PTH < 20 pg/mL had a sensitivity of 66.4% (95% CI 56.6–75.2%) and a specificity of 67.6% (95% CI 58.0–76.2%). Postoperative PTH decrease >50% had a sensitivity of 63.4% (95% CI 53.2–72.7%) and a specificity of 72.5% (95% CI 62.5–81.0%). Across all PTH thresholds, the false-negative rate was 33.6–63.5% indicating that up to 64% of patients with a normal PTH level could have been discharged without appropriate calcium supplementation. The false-positive rate was 10.8–32.4% indicating that up to 32.4% of patients with low PTH could have been treated with calcium supplementation unnecessarily. Conclusion: Following total thyroidectomy, PTH levels are unreliable in predicting hypocalcemia. Additional prospective studies are needed to understand the true utility of PTH levels post-thyroidectomy.

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