Protocol for management after thyroidectomy: a retrospective study based on one-center experience.

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Abstract

The optimal approach to detect and treat symptomatic hypocalcemia (SxH) after thyroidectomy is still uncertain. In our retrospective study, we sought to set a standardized postoperative management protocol on the basis of relative change of parathyroid hormone (PTH) and absolute value of postoperative day 1 (POD1) PTH.

Most cited references 19

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Hypocalcemia following thyroid surgery: incidence and prediction of outcome.

F. Pattou, F Combemale, S Fabre … (1998)

Postoperative hypocalcemia is a common and most often transient event after extensive thyroid surgery. It may reveal iatrogenic injury to the parathyroid glands and permanent hypoparathyroidism. We prospectively evaluated the incidence of hypocalcemia and permanent hypoparathyroidism following total or subtotal thyroidectomy in 1071 consecutive patients operated during 1990-1991. We then determined in a cross-sectional study which early clinical and biochemical characteristics of patients experiencing postoperative hypocalcemia correlated with the long-term outcome. Postoperative calcemia under 2 mmol/l was observed in 58 patients (5. 4%). In 40 patients hypocalcemia was considered severe (confirmed for more than 2 days, symptomatic or both). At 1 year after surgery five patients (0.5%) had persistent hypocalcemia. We found that patients carried a high risk for permanent hypoparathyroidism if fewer than three parathyroid glands were preserved in situ during surgery or the early serum parathyroid hormone level was /= 4 mg/dl under oral calcium therapy. When one or more of these criteria are present, long-term follow-up should be enforced to check for chronic hypocalcemia and to avoid its severe complications by appropriate supplement therapy.

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Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient.

T Reeve, N. W. Thompson (2000)

Surgery of the thyroid takes place in an area of complicated anatomy and in which a number of vital physiologic functions and special senses are controlled. Thyroidectomy rarely is associated with mortality; but unless the surgeon performing it is well trained in operative surgery and is knowledgeable of the gland and its function, pathology, and anatomy, excellent results cannot be achieved. Failure to observe cardinal surgical principles may result in legal difficulties, which can be avoided. It is well to observe the principles and avoid problems. We address this issue herein.

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Evidence for the role of perioperative PTH measurement after total thyroidectomy as a predictor of hypocalcemia.

Simon Grodski, Jonathan Serpell (2008)

Total thyroidectomy is now accepted worldwide as the standard surgical procedure for the management of benign bilateral nodular thyroid disease. Hypocalcemia is the most common complication of that procedure and a variety of strategies for diagnosing and managing post-thyroidectomy hypocalcemia have been advocated. Increasingly, the use of intact parathyroid hormone (PTH) has been utilized to try to predict those patients at risk of developing post-thyroidectomy hypocalcemia. A Medline search of English language literature was performed and we reviewed the evidence in relation to the following three issues: the accuracy of PTH in predicting hypocalcemia, the optimal timing for measuring PTH, and the routine use of oral calcium supplements. Post-thyroidectomy PTH levels accurately predict hypocalcemia but lack 100% accuracy. Progressive and severe hypocalcemia is unlikely in the setting of a normal PTH level and hence PTH can be cautiously used to facilitate discharge within 24 h for many patients. In addition, PTH levels can be used to implement early treatment with calcium and/or vitamin D supplements to reduce the incidence and severity of hypocalcemia. A single PTH measurement taken any time from 10 min to several hours postoperative will provide equally accurate results for predicting post-thyroidectomy hypocalcemia. Routine use of oral calcium supplements may reduce the incidence and severity of post-thyroidectomy hypocalcemia. Postoperative PTH can be used to stratify the risk of patients developing hypocalcemia after thyroidectomy. In addition, the routine use of oral calcium supplements can lead to decreased incidence and severity of post-thyroidectomy hypocalcemia. Protocols based on PTH and the routine use of oral calcium supplements can lead to improved patient outcomes after thyroidectomy.

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Author and article information

Journal

Journal ID (iso-abbrev): Ther Clin Risk Manag

Title: Therapeutics and clinical risk management

Publisher: Dove Medical Press Ltd.

ISSN: 1176-6336

ISSN (Print): 1176-6336

Publication date (Electronic): 2017

Volume: 13

Affiliations

[1 ] Thyroid & Breast Surgery.

[2 ] Nephrology.

[3 ] Biostatistics Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China.

Article

Publisher Item ID: tcrm-13-635

DOI: 10.2147/TCRM.S129910

PMC ID: 5437971

PubMed ID: 28546753

SO-VID: 5b08c9f6-3358-4adc-affa-0bc46d6c6a52

History

Keywords: PTH,calcitriol,discharge,parathyroid hormone,relative change,thyroidectomy

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Keywords: PTH, calcitriol, discharge, parathyroid hormone, relative change, thyroidectomy

Protocol for management after thyroidectomy: a retrospective study based on one-center experience.

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Abstract

Most cited references 19

Hypocalcemia following thyroid surgery: incidence and prediction of outcome.

Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient.

Evidence for the role of perioperative PTH measurement after total thyroidectomy as a predictor of hypocalcemia.

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