World Congress on Thyroid Cancer 3.5
June 20 – 22, 2019
World Congress on Thyroid Cancer 4.0
July 29 – August 1, 2021
WCTC3.5 Steering Committee:
Rocco Bellatone, Co-Chair
Celestino Lombardi, Co-Chair
Gregory W. Randolph, MD
Bryan McIver, MD
Jeremy Freeman, MD
Ian J. Witterick, MD
Ashok R. Shaha, MD
Jatin P. Shah, MD
EP68 – Postoperative PTH compared with IPTH gradient as predictors of post-thyroidectomy hypocalcemia; stratifying patients for outpatient thyroidectomy
Dhillon, Vaninder1; Al-Khadem, Mai1; Rettig, Eleni1; Tufano, Ralph P.1,2
1 Department of Otolaryngology, Head and Neck Surgery-Endocrine Surgery Division, Johns Hopkins University, Baltimore, MD, USA
2 Faculty, Chief of Endocrine Surgery Division, Department of Otolaryngology, Head and Neck Surgery-Endocrine Surgery Division, Johns Hopkins University, Baltimore, MD, USA
Background/Purpose: Predicting which patients will not develop symptoms from hypocalcemia after thyroidectomy may allow for same day discharge, even if calcium supplementation is required. Our objective is to assess the utility of pre and one-hour post-operative intact PTH (IPTH) gradient compared to the one-hour post-op IPTH alone to predict risk of severe hypocalcemia, and determine which patients require hospital admission for symptomatic hypocalcemia.
Methods: This was a retrospective review of patients who underwent primary total thyroidectomy by the senior author from May 2015 to May 2016. Logistic regression was used to evaluate differences in postoperative calcium and calcitriol supplementation requirement by IPTH gradient, and by quartile of absolute postoperative IPTH. Mild, severe and symptomatic hypocalcemia were defined.
Results: Overall, 119 patients were analyzed. 47% of patients developed any postoperative hypocalcemia, including 26 (22%) with mild and 30 (25%) with severe hypocalcemia. Thirteen patients had severe hypocalcemia that resolved with calcium supplementation. Postoperative IPTH and IPTH gradient were highly correlated (p<0.001). IPTH gradient was more strongly associated than postoperative IPTH. IPTH gradient was, however, a significantly better predictor of hypocalcemic symptoms than was postoperative IPTH (AUC 0.75; p=0.03). Risk groups for post-thyroidectomy hypocalcemia were created with high risk: IPTH gradient > 80%.
Discussion: IPTH gradient is more significantly associated with severe and symptomatic hypocalcemia compared to postoperative IPTH alone.
Conclusion: IPTH gradient > 80% can be used to assess patients at risk for severe and symptomatic hypocalcemic after thyroidectomy, and is a valuable metric to stratify those that require overnight hospitalization from same-day discharge with supplementation.
- Sun GH, DeMonner S, Davis MM. Epidemiological and economic trends in inpatient and outpatient thyroidectomy in the United States, 1996-2006. Thyroid : official journal of the American Thyroid Association. Jun 2013;23(6):727-73
- Terris DJ, Snyder S, Carneiro-Pla D, et al. American Thyroid Association statement on outpatient thyroidectomy. Thyroid : official journal of the American Thyroid Association. Oct 2013;23(10):1193-1202.
- Vescan A, Witterick I, Freeman J. Parathyroid hormone as a predictor of hypocalcemia after thyroidectomy. The Laryngoscope. Dec 2005;115(12):2105-2108.
- Pisaniello D, Parmeggiani D, Piatto A, et al. Which therapy to prevent post-thyroidectomy hypocalcemia? Il Giornale di chirurgia. Oct 2005;26(10):357-361.
- McHenry CR. “Same-day” thyroid surgery: an analysis of safety, cost savings, and outcome. The American surgeon. Jul 1997;63(7):586-589; discussion 589-590.
- Noureldine SI, Genther DJ, Lopez M, Agrawal N, Tufano RP. Early predictors of hypocalcemia after total thyroidectomy: an analysis of 304 patients using a short-stay monitoring protocol. JAMA otolaryngology– head & neck surgery. Nov 2014;140(11):1006-1013.
- Lecerf P, Orry D, Perrodeau E, et al. Parathyroid hormone decline 4 hours after total thyroidectomy accurately predicts hypocalcemia. Surgery. Nov 2012;152(5):863-868.
- Terris DJ, Moister B, Seybt MW, Gourin CG, Chin E. Outpatient thyroid surgery is safe and desirable. Otolaryngology–head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. Apr 2007;136(4):556-559.