{"title":"Postoperative parathyroid hormone (PTH) is equivalent to perioperative PTH drop in predicting postsurgical hypoparathyroidism.","authors":"M Hashem, C B Lim, S P Balasubramanian","doi":"10.1308/rcsann.2024.0001","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative surgical hypoparathyroidism (PoSH) following thyroid surgery is an established complication. Several predictive factors have been identified including perioperative parathyroid hormone (PTH) levels. The aim of the study is to compare the drop in perioperative PTH to postoperative day 1 PTH in predicting hypocalcaemia and hypoparathyroidism.</p><p><strong>Methods: </strong>Records of consecutive patients who had either total or completion thyroidectomy with or without central neck dissection in a 3-year period in a single thyroid surgery unit were accessed to retrieve data on demographics, pathology, surgery, perioperative biochemistry and management.</p><p><strong>Results: </strong>Of 295 included patients, there were 227 (76.9%) females. Forty-five (15.3%) had completion thyroidectomy, and the rest had total thyroidectomy. Seventy-eight (26.4%) had concomitant central neck dissection. Sixty-four (21.7%) had hypocalcaemia on the day after surgery. Hypoparathyroidism persisted in 10.5% of patients at 6 months. Both day 1 PTH and a drop in PTH predicted day 1 hypocalcaemia (<i>p</i> < 0.001) and 6-month hypoparathyroidism (<i>p</i> < 0.001). The area under the receiver operating characteristic (ROC) curves for day 1 PTH and drop in PTH for the prediction of day 1 hypocalcaemia (0.729 vs 0.726, respectively) and for 6-month hypoparathyroidism (0.964 vs 0.958, respectively) were similar, albeit slightly better for day 1 PTH.</p><p><strong>Conclusions: </strong>Day 1 PTH is equivalent to (if not better than) drop in PTH in predicting short- and long-term PoSH. Preoperative PTH measurements may not be needed in the detection and/or management of PoSH after thyroid surgery.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":null,"pages":null},"PeriodicalIF":1.1000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11214856/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of the Royal College of Surgeons of England","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1308/rcsann.2024.0001","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/3/13 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Postoperative surgical hypoparathyroidism (PoSH) following thyroid surgery is an established complication. Several predictive factors have been identified including perioperative parathyroid hormone (PTH) levels. The aim of the study is to compare the drop in perioperative PTH to postoperative day 1 PTH in predicting hypocalcaemia and hypoparathyroidism.
Methods: Records of consecutive patients who had either total or completion thyroidectomy with or without central neck dissection in a 3-year period in a single thyroid surgery unit were accessed to retrieve data on demographics, pathology, surgery, perioperative biochemistry and management.
Results: Of 295 included patients, there were 227 (76.9%) females. Forty-five (15.3%) had completion thyroidectomy, and the rest had total thyroidectomy. Seventy-eight (26.4%) had concomitant central neck dissection. Sixty-four (21.7%) had hypocalcaemia on the day after surgery. Hypoparathyroidism persisted in 10.5% of patients at 6 months. Both day 1 PTH and a drop in PTH predicted day 1 hypocalcaemia (p < 0.001) and 6-month hypoparathyroidism (p < 0.001). The area under the receiver operating characteristic (ROC) curves for day 1 PTH and drop in PTH for the prediction of day 1 hypocalcaemia (0.729 vs 0.726, respectively) and for 6-month hypoparathyroidism (0.964 vs 0.958, respectively) were similar, albeit slightly better for day 1 PTH.
Conclusions: Day 1 PTH is equivalent to (if not better than) drop in PTH in predicting short- and long-term PoSH. Preoperative PTH measurements may not be needed in the detection and/or management of PoSH after thyroid surgery.
简介甲状腺手术后甲状旁腺功能减退症(PoSH)是一种公认的并发症。目前已确定了一些预测因素,包括围手术期甲状旁腺激素(PTH)水平。本研究旨在比较围手术期PTH与术后第1天PTH的降幅,以预测低钙血症和甲状旁腺功能减退症:方法:访问一个甲状腺外科单位3年内连续接受甲状腺全切除术或甲状腺完全切除术(带或不带颈部中央切除术)的患者记录,检索有关人口统计学、病理学、手术、围手术期生化和管理的数据:在纳入的295名患者中,有227名(76.9%)女性。45人(15.3%)进行了甲状腺完全切除术,其余患者进行了甲状腺全切除术。78人(26.4%)同时进行了颈部中央切除术。64例(21.7%)患者在术后第二天出现低钙血症。10.5%的患者在术后6个月仍出现甲状旁腺功能减退。第1天的PTH和PTH下降均可预测第1天的低钙血症(p < 0.001)和6个月的甲状旁腺功能减退(p < 0.001)。第1天PTH和PTH下降预测第1天低钙血症(分别为0.729 vs 0.726)和预测6个月甲状旁腺功能减退(分别为0.964 vs 0.958)的接收器操作特征曲线下面积相似,但第1天PTH略好:在预测短期和长期PoSH方面,第1天的PTH与PTH下降值相当(甚至优于PTH下降值)。甲状腺手术后PoSH的检测和/或管理可能不需要术前PTH测量。
期刊介绍:
The Annals of The Royal College of Surgeons of England is the official scholarly research journal of the Royal College of Surgeons and is published eight times a year in January, February, March, April, May, July, September and November.
The main aim of the journal is to publish high-quality, peer-reviewed papers that relate to all branches of surgery. The Annals also includes letters and comments, a regular technical section, controversial topics, CORESS feedback and book reviews. The editorial board is composed of experts from all the surgical specialties.