Preoperative parathyroid hormone level as a predictive factor for post-thyroidectomy hypoparathyroidism

Purpose: Whether the level of the preoperative parathyroid hormone (PTH) is a risk factor of postoperative hypoparathyroidism remains unclear. The aim of this study was to evaluate the predictive value of preoperative PTH for the hypoparathyroidism following total thyroidectomy. Methods: Five hundred two patients performed total thyroidectomy from January 2009 to July 2010 in Seoul National University Hospital were enrolled. Demographics, operative variables, and the development of hypoparathyroidism were collected and evaluated. Results: A total of 502 patients were enrolled during the study period. Patients had a mean age of 48.1±12.1 years (range, 16 to 95 years) and showed a female predominance (n=420, 83.7%). Preoperative PTH of 44.5 pg/mL was recommended as cut-off value. Transient hypoparathyroidism developed 2.4 times (95% confidence interval [CI], 1.1 to 5.1) more frequently in low PTH group (P=0.021). Percentage decline of the preoperative PTH also showed significant association with transient hypoparathyroidism. When the value of 73.9% decline was used, the chance of transient hypoparathyroidism was 3.3 times (95% CI, 2.0 to 5.5) higher in high percentage decline group (P Conclusion: Preoperative PTH level and percentage decline can be used as a predictive factor for postoperative hypoparathyroidism. In patients with low PTH level (<44.5 pg/mL), caution should be given to prevent injury of the parathyroid glands.

[1]  Sun Jin Park,et al.  The use of aprepitant in the first cycle of moderately emetogenic chemotherapy in patients with colorectal cancer: its preventive effect on chemotherapy-induced nausea and vomiting , 2013 .

[2]  B. Song,et al.  Clinical axillary nodal staging in breast cancer using preoperative ultrasonography , 2013 .

[3]  K. Jung,et al.  Cancer Statistics in Korea: Incidence, Mortality, Survival and Prevalence in 2010 , 2013, Cancer research and treatment : official journal of Korean Cancer Association.

[4]  S. Tiefenbrun.  FORT LAUDERDALE (Florida) , 2012 .

[5]  K. Markou,et al.  Complications and risk factors related to the extent of surgery in thyroidectomy. Results from 2,043 procedures , 2010, Hormones.

[6]  H. Issever,et al.  The impact of age, vitamin D(3) level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy. , 2009, American journal of surgery.

[7]  A. Pfleiderer,et al.  The timing of calcium measurements in helping to predict temporary and permanent hypocalcaemia in patients having completion and total thyroidectomies. , 2009, Annals of the Royal College of Surgeons of England.

[8]  J. Roh,et al.  Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection , 2009, Cancer.

[9]  N. Palestini,et al.  Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience , 2008, Langenbeck's Archives of Surgery.

[10]  K. Kaczirek,et al.  Hypoparathyroidism after total thyroidectomy: a prospective study. , 2008, Archives of surgery.

[11]  C. Lombardi,et al.  Parathyroid hormone levels 4 hours after surgery do not accurately predict post-thyroidectomy hypocalcemia. , 2006, Surgery.

[12]  S. Sidhu,et al.  Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. , 2006, Surgery.

[13]  P. Del Rio,et al.  The Utility of Serum PTH Assessment 24 Hours after Total Thyroidectomy , 2005, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[14]  D. Gillett,et al.  Management of serum calcium levels in post-thyroidectomy patients. , 2004, Clinical otolaryngology and allied sciences.

[15]  W. Fraser,et al.  The physiology of the circadian rhythm of parathyroid hormone and its potential as a treatment for osteoporosis , 2004, Current opinion in nephrology and hypertension.

[16]  E. Mittendorf,et al.  Post-Parathyroidectomy Hypocalcemia: Incidence, Risk Factors, and Management , 2004, The American surgeon.

[17]  N. Thompson,et al.  Complications of Thyroid Surgery: How to Avoid Them, How to Manage Them, and Observations on Their Possible Effect on the Whole Patient , 2000, World Journal of Surgery.

[18]  P. Neuhaus,et al.  Complications associated with different surgical approaches to differentiated thyroid carcinoma , 1999, Langenbeck's Archives of Surgery.

[19]  F. Pattou,et al.  Hypocalcemia following Thyroid Surgery: Incidence and Prediction of Outcome , 1998, World Journal of Surgery.

[20]  T. Defechereux,et al.  Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma , 1998, Langenbeck's Archives of Surgery.

[21]  T. Speroff,et al.  Risk factors for postthyroidectomy hypocalcemia. , 1994, Surgery.

[22]  W Barrett,et al.  MANAGING TRANSPORTATION PLANNING NETWORKS IN A GIS-T ENVIRONMENT , 1994 .

[23]  M. Rossetti,et al.  JOURNEY TO WORK TRENDS IN THE UNITED STATES AND ITS MAJOR METROPOLITAN AREAS, 1960-1990. FINAL REPORT , 1993 .

[24]  Chuan Yi Tang,et al.  A 2.|E|-Bit Distributed Algorithm for the Directed Euler Trail Problem , 1993, Inf. Process. Lett..

[25]  Charles Lave,et al.  Cars and Demographics , 1992 .

[26]  D T Hartgen,et al.  A GEOGRAPHIC INFORMATION SYSTEM APPLICATION TO REGIONAL SUBAREA TRANSPORTATION MODELING , 1992 .

[27]  V. De Maertelaer,et al.  Hypocalcemia after thyroidectomy. , 1992, Archives of surgery.

[28]  J M Shrouds,et al.  TRANSPORTATION PLANNING REQUIREMENTS OF THE FEDERAL CLEAN AIR ACT AMENDMENTS (CAAAS) OF 1990: A HIGHWAY PERSPECTIVE. 30TH ANNUAL WORKSHOP ON TRANSPORTATION LAW, SNOWBIRD CONFERENCE CENTER, SNOWBIRD, UTAH, JULY 21-25, 1991 , 1991 .

[29]  Reginald R. Souleyrette,et al.  RELATIONS BETWEEN TRANSPORTATION AND PRODUCTION , 1990 .

[30]  Arnulf Grubler,et al.  The Rise and Fall of Infrastructures: Dynamics of Evolution and Technological Change in Transport , 1990 .

[31]  S Lewis,et al.  USE OF GEOGRAPHICAL INFORMATION SYSTEMS IN TRANSPORTATION MODELING , 1990 .

[32]  R. Burney,et al.  Total thyroidectomy: Complications and technique , 1986, World Journal of Surgery.

[33]  P Spaulding,et al.  NATIONAL TRANSPORTATION STATISTICS. ANNUAL REPORT , 1983 .

[34]  L. Deftos,et al.  The role of calcitonin and parathyroid hormone in the pathogenesis of post-thyroidectomy hypocalcemia. , 1981, Metabolism: clinical and experimental.

[35]  L. Orloff,et al.  Prospective study of perioperative factors predicting hypocalcemia after thyroid and parathyroid surgery. , 2006, Archives of otolaryngology--head & neck surgery.

[36]  E. Brown,et al.  The parathyroid hormone circadian rhythm is truly endogenous--a general clinical research center study. , 1997, The Journal of clinical endocrinology and metabolism.

[37]  Debbie A. Niemeier,et al.  GIS AND TRANSPORTATION PLANNING -- A CASE STUDY. , 1993 .

[38]  Shih-Lung Shaw,et al.  GIS for urban travel demand analysis: Requirements and alternatives , 1993 .

[39]  Tsai,et al.  ADAPTATION OF GEOGRAPHIC INFORMATION SYSTEMS FOR TRANSPORTATION , 1993 .

[40]  David T Hartgen,et al.  SUPER-REGIONAL VERY LONG RANGE TRANSPORTATION MODELING WITH A GIS , 1992 .

[41]  Keechoo Choi,et al.  THE IMPLEMENTATION OF AN INTEGRATED TRANSPORTATION PLANNING MODEL WITH GIS AND EXPERT SYSTEMS FOR INTERACTIVE TRANSPORTATION PLANNING. , 1992 .

[42]  Roger L. Wayson,et al.  Transportation Planning and Air Quality , 1992 .

[43]  Patrick DeCorla-Souza,et al.  VMT for Air Quality Purposes , 1992 .

[44]  W Barrett,et al.  BUILDING A REGIONAL TRANSPORTATION MODEL WITH GIS SOFTWARE , 1991 .

[45]  W. O'Neill.  DEVELOPING OPTIMAL TRANSPORTATION ANALYSIS ZONES USING GIS , 1991 .

[46]  D Kriger,et al.  INTEGRATION OF GIS WITH THE TRANSPORTATION DEMAND MODEL TMODEL 2 AT SASKATCHEWAN DEPARTMENT OF HIGHWAYS AND TRANSPORTATION , 1991 .

[47]  G N Steuart,et al.  DEVELOPING TRANSPORTATION NETWORKS USING AREA MASTER FILES AND AUTOCAD . PROCEEDINGS OF THE 1989 ANNUAL CONFERENCE OF THE ROADS AND TRANSPORTATION ASSOCIATION OF CANADA, CALGARY, ALBERTA, SEPTEMBER 17-21, 1989 , 1989 .

[48]  M. Replogle,et al.  INTEGRATION OF A GEOGRAPHIC INFORMATION SYSTEM WITH COMPUTER TRANSPORTATION MODELS FOR LAND USE AND TRANSPORTATION PLANNING , 1989 .

[49]  Howard J Simkowitz,et al.  GEOGRAPHIC INFORMATION SYSTEMS: AN IMPORTANT TECHNOLOGY FOR TRANSPORTATION PLANNING AND OPERATIONS , 1989 .

[50]  Robert Herman,et al.  Cities and their vital systems : infrastructure past, present, and future , 1988 .

[51]  M. Baucus.  Transportation Research Board , 1982 .