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Hypocalcaemia following total thyroidectomy: early post-operative parathyroid hormone assay as a risk stratification and management tool

Published online by Cambridge University Press:  24 March 2014

S Islam ,
T Al Maqbali ,
D Howe  and
J Campbell
S Islam*
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Birmingham Heartlands Hospital, UK
T Al Maqbali
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Birmingham Heartlands Hospital, UK
D Howe
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Birmingham Heartlands Hospital, UK
J Campbell
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Birmingham Heartlands Hospital, UK
*
Address for correspondence: Mr Shofiq Islam, Department of Otolaryngology and Head and Neck Surgery, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK E-mail: drshafiqislam@hotmail.co.uk
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Abstract

Objective:

To develop a practical, efficient and predictive algorithm to manage potential or actual post-operative hypocalcaemia after complete thyroidectomy, using a single post-operative parathyroid hormone assay.

Methods:

This paper reports a prospective study of 59 patients who underwent total or completion thyroidectomy over a period of 24 months. Parathyroid hormone levels were checked post-operatively on the day of surgery, and all patients were evaluated for hypocalcaemia both clinically and biochemically with serial corrected calcium measurements.

Results:

No patient with an early post-operative parathyroid hormone level of 23 ng/l or more (i.e. approximately twice the lower limit of the normal range) developed hypocalcaemia. All the patients who initially had post-operative hypocalcaemia but had an early parathyroid hormone level of 8 ng/l or more (i.e. approximately two-thirds of the lower limit of the normal range) had complete resolution of their hypocalcaemia within three months.

Conclusion:

Early post-operative parathyroid hormone measurement can reliably predict patients at risk of post-thyroidectomy hypocalcaemia, and predict those patients expected to recover from temporary hypocalcaemia. A suggested post-operative management algorithm is presented.

Keywords

ThyroidectomyHypocalcemiaHypoparathyroidismParathyroid HormonePostoperative CareRisk Factors
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 3 , March 2014 , pp. 274 - 278
Copyright
Copyright © JLO (1984) Limited 2014 

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