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Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies.

Publication ,  Journal Article
Noordzij, JP; Lee, SL; Bernet, VJ; Payne, RJ; Cohen, SM; McLeod, IK; Hier, MP; Black, MJ; Kerr, PD; Richards, ML; Lo, CY; Raffaelli, M ...
Published in: J Am Coll Surg
December 2007

BACKGROUND: Monitoring for hypocalcemia after thyroidectomy, using only symptoms and serum calcium levels, can delay the discharge of patients who will remain normocalcemic and can delay the treatment of hypocalcemic patients. STUDY DESIGN: We conducted a systematic search for articles describing use of parathyroid hormone (PTH) assay, checked within hours of completing thyroidectomy, to predict postoperative symptomatic hypocalcemia. Studies were excluded if all patients were treated with postoperative calcium, or if early PTH values were used to alter management of the patient. Individual patient data (perioperative PTH and calcium levels, development of hypocalcemia) were obtained for 457 patients from the corresponding authors of 9 studies and pooled to yield the following results. RESULTS: PTH, checked at three time periods after removal of the thyroid gland (0 to 20 minutes, 1 to 2 hours, and 6 hours), was substantially lower in patients who became hypocalcemic compared with those who remained normocalcemic. The accuracy of PTH in determining hypocalcemia increased with time and was excellent when checked 1 to 6 hours postoperatively. A single PTH threshold (65% decrease compared with preoperative level), checked 6 hours after completing thyroidectomy, had a sensitivity of 96.4% and specificity of 91.4% in detecting postoperative hypocalcemia. CONCLUSIONS: PTH assay, when checked 1 to 6 hours after thyroidectomy, has excellent accuracy in determining which patients will become symptomatically hypocalcemic. Routine use of this assay should be considered because it may allow earlier discharge of the normocalcemic patient and earlier identification of patients requiring treatment of postthyroidectomy hypocalcemia.

Duke Scholars

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

December 2007

Volume

205

Issue

6

Start / End Page

748 / 754

Location

United States

Related Subject Headings

  • Time Factors
  • Thyroidectomy
  • Surgery
  • ROC Curve
  • Predictive Value of Tests
  • Parathyroid Hormone
  • Hypocalcemia
  • Humans
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

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Noordzij, J. P., Lee, S. L., Bernet, V. J., Payne, R. J., Cohen, S. M., McLeod, I. K., … Dietrich, M. S. (2007). Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies. J Am Coll Surg, 205(6), 748–754. https://doi.org/10.1016/j.jamcollsurg.2007.06.298
Noordzij, J Pieter, Stephanie L. Lee, Victor J. Bernet, Richard J. Payne, Seth M. Cohen, Ian K. McLeod, Michael P. Hier, et al. “Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies.J Am Coll Surg 205, no. 6 (December 2007): 748–54. https://doi.org/10.1016/j.jamcollsurg.2007.06.298.
Noordzij JP, Lee SL, Bernet VJ, Payne RJ, Cohen SM, McLeod IK, et al. Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies. J Am Coll Surg. 2007 Dec;205(6):748–54.
Noordzij, J. Pieter, et al. “Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies.J Am Coll Surg, vol. 205, no. 6, Dec. 2007, pp. 748–54. Pubmed, doi:10.1016/j.jamcollsurg.2007.06.298.
Noordzij JP, Lee SL, Bernet VJ, Payne RJ, Cohen SM, McLeod IK, Hier MP, Black MJ, Kerr PD, Richards ML, Lo CY, Raffaelli M, Bellantone R, Lombardi CP, Cohen JI, Dietrich MS. Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies. J Am Coll Surg. 2007 Dec;205(6):748–754.
Journal cover image

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

December 2007

Volume

205

Issue

6

Start / End Page

748 / 754

Location

United States

Related Subject Headings

  • Time Factors
  • Thyroidectomy
  • Surgery
  • ROC Curve
  • Predictive Value of Tests
  • Parathyroid Hormone
  • Hypocalcemia
  • Humans
  • 3202 Clinical sciences
  • 1103 Clinical Sciences