Early Prediction of Post Thyroidectomy Hypocalcemia by Measuring Parathyroid Hormone

Farhad  Mustafa; Atif Imran Zaheer Shah; Amanat Ali Shah; Muhammad Umair Adeel; Muhammad Usman Afzal Malik; Afaf  Yousaf

doi:10.51253/pafmj.v76i4.13029

Authors

Farhad Mustafa Department of ENT, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Atif Imran Zaheer Shah Department of ENT, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Amanat Ali Shah Department of ENT, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Muhammad Umair Adeel Department of ENT, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Muhammad Usman Afzal Malik Department of ENT, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Afaf Yousaf Department of ENT, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76i4.13029

Keywords:

Calcium, Hypocalcemia, Parathyroid, Post-Thyroidectomy

Abstract

Objective: To predict patients at risk of developing post-operative hypocalcemia by measuring parathyroid hormone (PTH) and serum calcium and early initiation of oral calcium and vitamin D in these patients to decrease complications.

Study Design: Prospective, observational study.

Place and Duration of Study: Department of Otolaryngology, Combined Military Hospital Rawalpindi, Pakistan, from Sep 2022 to Aug 2023.

Methodology: A total of 160 patients were included in the study group segregated into those who developed hypocalcemia (Group-A) versus normocalcemia (Group-B) post-operatively. Primary variables studied were mean levels of PTH for corresponding values of hypo or normocalcemia, frequency of patients presenting with normo versus hypocalcemia. Secondary variables of study were the sensitivity and specificity of PTH in predicting hypocalcemia.

Results: The incidence of hypocalcemia in the study group was seen in 63(39.4%) patients and normocalcemia was seen in 97 (60.6%) patients. The ability of PTH in predicting hypocalcemia at 01- and 24-hour intervals showed sensitivity of 90.5% and a specificity of 79.4% at one hour while the sensitivity at 24 hours was 95.2% with a specificity of 96.9%.

Conclusion: We conclude that falling levels of PTH hormones post-thyroidectomy showed excellent sensitivity and specificity in predicting hypocalcemia at 01 and 24 hours respectively.

Downloads

Download data is not yet available.

References

Kazaure HS, Zambeli-Ljepovic A, Oyekunle T, Roman SA, Sosa JA, Stang MT, et al. Severe hypocalcemia after thyroidectomy: an analysis of 7366 patients. Ann Surg 2021; 274(6): e1014-e1021.

https://doi.org/10.1097/SLA.0000000000003725

2. Qin Y, Sun W, Wang Z, Dong W, He L, Zhang T, et al. A meta-analysis of risk factors for transient and permanent hypocalcemia after total thyroidectomy. Front Oncol 2021; 10: 614089. https://doi.org/10.3389/fonc.2020.614089

3. Torabi SJ, Avery JM, Salehi PP, Lee Y. Risk factors and effects of hypocalcemia prior to discharge following thyroidectomy. Am J Otolaryngol 2020; 41(3): 102420.

https://doi.org/10.1016/j.amjoto.2020.102420

4. Aghdam AM, Rousta F. Prevalence of Hypocalcemia Following Thyroidectomy. Eurasian J Chem Med Pet Res 2023; 2(3): 12-23.

https://doi.org/10.5281/zenodo.8004704

5. Casey C, Hopkins D. The role of preoperative vitamin D and calcium in preventing post-thyroidectomy hypocalcaemia: a systematic review. Eur Arch Otorhinoaryngol 2023; 280(4): 1555-1563. https://doi.org/10.1007/s00405-022-07791-z

6. Shonka Jr DC, Maxwell AK, Petroni GR, Jameson MJ. Phase II randomized study of preoperative calcitriol to prevent hypocalcemia following thyroidectomy. Head Neck 2021; 43(10): 2935-2945. https://doi.org/10.1002/hed.26775

7. Azadbakht M, Emadi-Jamali SM, Azadbakht S. Hypocalcemia following total and subtotal thyroidectomy and associated factors. Ann Med Surg 2021; 66: 102417.

https://doi.org/10.1016/j.amsu.2021.102417

8. Zheng XG, Xu CY. Role of Preoperative Calcium and Vitamin D Supplementation in Preventing Post-total Thyroidectomy Hypocalcemia: a Systematic Review and Meta-analysis. Indian J Surg 2024; 86(3): 499-508.

https://doi.org/10.1007/s12262-023-03896-9

9. Paladino NC, Guérin C, Graziani J, Morange I, Loundou A, Taïeb D, et al. Predicting risk factors of postoperative hypocalcemia after total thyroidectomy: is safe discharge without supplementation possible? A large cohort study. Langenbecks Arch Surg 2021; 406(7): 2425-2431.

https://doi.org/10.1007/s00423-021-02237-2

10. Strajina V, Dy BM, McKenzie TJ, Thompson GB, Lyden ML. Predicting postthyroidectomy hypocalcemia: improving predictive ability of parathyroid hormone level. Am Surg 2020; 86(2): 121-126. https://doi.org/10.1177/000313482008600231

11. Mo K, Shang J, Wang K, Gu J, Wang P, Nie X, et al. Parathyroid hormone reduction predicts transient hypocalcemia after total thyroidectomy: a single‐center prospective study. Int J Endocrinol 2020; 2020(1): 7189857.

https://doi.org/10.1155/2020/7189857

12. Aimon S, Altaf HN, Latif S, Farooqui F, Khan S, Amir M. Role of Postoperative Intact Parathyroid Hormone Levels in Predicting Hypocalcaemia after Thyroidectomy. J Coll Physicians Surg Pak 2024; 34(7): 828-831.

https://doi.org/10.29271/jcpsp.2024.07.828

13. Sulibhavi A, Rubin SJ, Park J, Hashemi S, DePietro JD, Noordzij JP. Preventative and management strategies of hypocalcemia after thyroidectomy among surgeons: an international survey study. Am J Otolaryngol 2020; 41(3): 102394.

https://doi.org/10.1016/j.amjoto.2020.102394

14. Metere A, Biancucci A, Natili A, Intini G, Graves CE. PTH after thyroidectomy as a predictor of post-operative hypocalcemia. Diagnostics 2021; 11(9): 1733.

https://doi.org/10.3390/diagnostics11091733

15. Abdullah AS. The role of early postoperative parathyroid hormone level after total thyroidectomy in prediction of hypocalcemia. Ann Med Surg 2021; 65.

https://doi.org/10.1016/j.amsu.2021.102252

16. Bashir AY, Alzubaidi AN, Bashir MA, Obed AH, Zakarneh RK, Ennab HZ, et al. The optimal parathyroid hormone cut-off threshold for early and safe management of hypocalcemia after total thyroidectomy. Endocrine Pract 2021; 27(9): 925-933.

https://doi.org/10.1016/j.eprac.2021.02.014

17. Lee YH, Liu Z, Zheng L, Qiu J, Sang J, Guan W. The rate of postoperative decline in parathyroid hormone levels can predict symptomatic hypocalcemia following thyroid cancer surgery with neck lymph node dissection. Nutr Cancer 2025; 77(1): 1-8.

https://doi.org/10.1080/01635581.2024.2401179

18. Swift WM, Iorio CB, Hamdi OA, Mallawaarachchi I, Wages NA, Shonka Jr DC. Change in parathyroid hormone levels from baseline predicts hypocalcemia following total or completion thyroidectomy. Head Neck 2022; 44(7): 1588-1595.

https://doi.org/10.1002/hed.27057