Combining Early Postoperative Parathyroid Hormone and Serum Calcium Levels Allows for an Efficacious Selective Post-thyroidectomy Supplementation Treatment
Marco Raffaelli
Division of General and Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
Search for more papers by this authorCorresponding Author
Carmela De Crea
Division of General and Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
U.O. di Chirurgia Generale ed Endocrina, Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168 Rome, Italy
[email protected]Search for more papers by this authorCinzia Carrozza
Institute of Biochemistry, Università Cattolica del Sacro Cuore, Rome, Italy
Search for more papers by this authorGerardo D’Amato
Division of General and Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
Search for more papers by this authorCecilia Zuppi
Institute of Biochemistry, Università Cattolica del Sacro Cuore, Rome, Italy
Search for more papers by this authorRocco Bellantone
Division of General and Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
Search for more papers by this authorCelestino P. Lombardi
Division of General and Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
Search for more papers by this authorMarco Raffaelli
Division of General and Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
Search for more papers by this authorCorresponding Author
Carmela De Crea
Division of General and Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
U.O. di Chirurgia Generale ed Endocrina, Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168 Rome, Italy
[email protected]Search for more papers by this authorCinzia Carrozza
Institute of Biochemistry, Università Cattolica del Sacro Cuore, Rome, Italy
Search for more papers by this authorGerardo D’Amato
Division of General and Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
Search for more papers by this authorCecilia Zuppi
Institute of Biochemistry, Università Cattolica del Sacro Cuore, Rome, Italy
Search for more papers by this authorRocco Bellantone
Division of General and Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
Search for more papers by this authorCelestino P. Lombardi
Division of General and Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
Search for more papers by this authorPresented at the ISW 2011-IAES free paper session, Pacifico Yokohama, Japan, 28 August-1 September 2011
Abstract
Background
Optimal treatment protocol to prevent symptomatic hypocalcemia following total thyroidectomy is still matter of debate. We prospectively evaluated the efficacy of a selective supplementation protocol based on both early postoperative intact parathyroid hormone (iPTH) and serum calcium levels.
Methods
Two hundred thirty consecutive patients were divided in three different groups of treatment according to iPTH levels 4 h after total thyroidectomy (4 h-iPTH) and serum calcium levels in the first postoperative day (1PO-Ca): group A (4 h-iPTH > 10 pg/ml, 1PO-Ca ≥ 8.5 mg/dl), no treatment; group B (4 h-iPTH > 10 pg/ml, 1PO-Ca < 8.5 mg/dl), oral calcium (OC) 3 g per day; and group C (4 h-iPTH ≤ 10 pg/ml), OC 3 g + calcitriol (VD) 1 μg per day. Development of biochemical and/or symptomatic hypocalcemia was evaluated.
Results
Fifty-nine patients (25.6%) had subnormal 4 h-iPTH levels (≤10 pg/ml) (group C). Among patients with normal 4 h-iPTH levels, 25 (10.9%) had subnormal 1PO-Ca (<8.5 mg/dl) (group B). The remaining 146 patients (63.5%) had normal 4 h-iPTH and 1PO-Ca levels (group A). One patient in group A, 2 in group B, and 18 in group C developed biochemical hypocalcemia. Only one patient in group C experienced major symptoms. Treatment was discontinued within 1 month in all the patients in group B. At a mean follow-up of 303 days, five patients in group C were still under supplementation treatment.
Conclusion
The proposed supplementation protocol seems efficacious in preventing symptomatic hypocalcemia. It could allow a safe and early discharge of most patients, thus avoiding the constraints and the costs of routine supplementation.
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