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Inicio Cirugía Española (English Edition) Prediction of post-idroidectomy hypocalcemia through rapid PTH determination
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Vol. 99. Issue 2.
Pages 115-123 (February 2021)
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Vol. 99. Issue 2.
Pages 115-123 (February 2021)
Original article
DOI: 10.1016/j.cireng.2021.01.016
Prediction of post-idroidectomy hypocalcemia through rapid PTH determination
Predicción de hipocalcemia postiroidectomía mediante determinación de PTH rápida
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Gonzalo Gutiérrez Fernándeza,
Corresponding author
gonzalo.gutierrez@scsalud.es

Corresponding author.
, Antonio López Userosa, Pedro Muñoz Cachob, Daniel Casanova Rituertoa
a Servicio Cirugía General, Unidad Cirugía Endocrino-Metabólica, Hospital Universitario Marques de Valdecilla, Santander, Spain
b Unidad Docente de Medicina Familiar y Comunitaria, Servicio Cántabro de Salud, Santander, Spain
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Tables (4)
Table 1. Demographic and clinical characteristics of patients from Groups A and B, as well as the control group.
Table 2. Biochemical data of Groups A and B regarding calcium and PTHr, at different times in the surgical process.
Table 3. Comparison of Groups A, B and Control regarding calcium and PTHr, at different times of the surgical process.
Table 4. Evaluation of different cut-off points of the variables: percentage of drop in PTHr, PTHr postop and calcium after 24 h.
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Abstract
Introduction

Hypocalcemia is the most frequent complication after thyroidectomy. The aim of this work is to identify biochemical risk factors of hypocalcemia using quick perioperative (pre and post-thyroidectomy) intact parathyroid hormone (PTHi) and postoperative calcemias.

Methods

In a consecutive series of 310 total thyroidectomies, samples of quick PTHi at the anaesthetic induction and 10 min after surgery, together with serum calcemias every 12 h were obtained. The sensitivity, specificity, positive and negative predictive value are analyzed and related to hypocalcemia. A control group of hemithyroidectomies is also analyzed to compare the effects of surgery on PTH secretion.

Results

Of the 310 patients, 202 (65.1%) remained normocalcemic and asymptomatic (group A), 108 (34.9%) presented hypocalcemia (Group B), requiring oral calcium (79 symptomatic). After analysis of several cut-off points, combining a PTHr drop gradient of 60% or calcemia inferior to 7.4 mg/dl at 24 h, a sensitivity of 100% is achieved without leaving false negatives. Compared to the control group, there is a significant difference with respect to the post-operative calcemias and PTHr, p < 0.001.

Conclusions

Total thyroidectomy affects parathyroid function with evident decrease in rPTH and risk of hypocalcemia. The combination of PTHr decrease of 60% or less than 7.4 mg/dl calcemia at 24 h gives a 100% sensitivity for predicting patients at risk of hypocalcemia.

Keywords:
PTH thyroidectomy
Hypocalcemia
Parathyroid hormone
Resumen
Introducción

La hipocalcemia es la complicación que condiciona el postoperatorio de la tiroidectomía. El objetivo de este trabajo es identificar criterios bioquímicos de riesgo de hipocalcemia analizando niveles de paratohormona rápida (PTHir) pre y postiroidectomía y de calcemias postoperatorias.

Métodos

Se recoge una serie consecutiva de 310 tiroidectomías totales, obteniendo muestras de PTHr basal y tras 10 minutos postiroidectomía, junto a calcemias séricas cada 12 horas. Se estudian dos grupos, A normocalcémicos, B hipocalcémicos. Se calcula la sensibilidad, especificidad, valor predictivo positivo y negativo en relación con la hipocalcemia utilizando las curvas ROC y sus áreas bajo la curva. Se analiza un grupo control de 48 hemitiroidectomías para comparar los efectos de la cirugía sobre la secreción de PTH.

Resultados

De los 310 pacientes, 202 (65,1%) se mantuvieron normocalcémicos y asintomáticos (grupo A), 108 (34,9%) presentaron hipocalcemia Grupo B, precisando calcio oral (79 sintomáticos). Tras el análisis de varios puntos de corte, combinando un gradiente de descenso de PTHr del 60% o una calcemia menor de 7,4 mg/dL a las 24 horas se consigue una sensibilidad del 100% sin dejar falsos negativos. Comparando con el grupo de control existe una diferencia significativa respecto de las calcemias y la PTHr postoperatorias.

Conclusiones

La tiroidectomía total afecta la función paratiroidea con descenso evidente de PTHr y riesgo de hipocalcemia. La combinación de un descenso del 60% o la calcemia inferior a 7,4 mg/dL a las 24 horas obtiene una sensibilidad del 100% para la predicción de pacientes en riesgo de hipocalcemia.

Palabras clave:
PTH tiroidectomía
Hipocalcemia
Paratohormona

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