Intact parathyroid hormone measurement at 24 hours after thyroid surgery as predictor of parathyroid function at long term

Abstract Background There is no consensus about the usefulness of postoperative intact parathyroid hormone (iPTH) determination to predict permanent hypoparathyroidism (pHPP). We evaluated the value of calcium (Ca2+ ) and iPTH concentration at 24 hours after total thyroidectomy (TT) for predicting p...

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Bibliographic Details
Published in:The American journal of surgery 2013-11, Vol.206 (5), p.783-789
Main Authors: Julián, María Teresa, M.D, Balibrea, Jose María, M.D., Ph.D, Granada, María Luisa, M.D., Ph.D, Moreno, Pau, M.D, Alastrué, Antonio, M.D., Ph.D, Puig-Domingo, Manel, M.D., Ph.D, Lucas, Anna, M.D., Ph.D
Format: Article
Language:English
Subjects:
Automation
Calcium - blood
Female
Hormones
Humans
Hypoparathyroidism - diagnosis
Immunoassay
Male
Middle Aged
Parathyroid Hormone - blood
Permanent hypoparathyroidism
Postoperative hypocalcemia
Postoperative Period
Predictive Value of Tests
Prospective Studies
ROC Curve
Sensitivity and Specificity
Surgery
Thyroidectomy
Time Factors
Total thyroidectomy
Vitamin D
Vitamin deficiency
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Summary:Abstract Background There is no consensus about the usefulness of postoperative intact parathyroid hormone (iPTH) determination to predict permanent hypoparathyroidism (pHPP). We evaluated the value of calcium (Ca2+ ) and iPTH concentration at 24 hours after total thyroidectomy (TT) for predicting pHPP. Methods Ca2+ and iPTH levels from 70 consecutive patients who underwent TT were measured at 24 hours and 6 months after TT. Results Five patients (7.1%) developed pHPP. An iPTH concentration ≤5.8 pg/mL at 24 hours after TT identified patients at risk for pHPP (sensitivity, 100%; specificity, 81.5%), but it was not accurate enough to predict its development (positive predictive value, 30%). Conversely, an iPTH level >5.8 pg/mL predicted normal parathyroid function at 6 months (negative predictive value, 100%). Compared with iPTH, a postoperative Ca2+ level ≤1.95 mmol/L was 60% sensitive and 78.5% specific to predict pHPP. Conclusions An iPTH concentration >5.8 pg/mL on the first postoperative day rules out pHPP with much better diagnostic accuracy than Ca2+ . Postoperative iPTH could be helpful in identifying patients at risk for developing pHPP.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2013.01.038