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

Abstract
Background  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.

Methods  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.

Results  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.

Conclusion  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.

Content Type Journal ArticleDOI 10.1007/s00268-008-9545-5Authors
Simon Grodski, Monash University Endocrine Surgery Unit The Alfred Hospital Melbourne VIC 3144 AustraliaJonathan Serpell, Monash University Endocrine Surgery Unit The Alfred Hospital Melbourne VIC 3144 Australia

Journal World Journal of SurgeryOnline ISSN 1432-2323Print ISSN 0364-2313 (Source: World Journal of Surgery)