BACKGROUND: Hypocalcaemia after thyroidectomy is thought to result from surgical damage to the parathyroid glands. This study analysed postoperative outcomes related to perioperative parathyroid hormone (PTH) levels. METHODS: Some 402 consecutive patients undergoing thyroid surgery were studied prospectively to monitor perioperative changes in serum PTH and Ca2+ levels, and clinical symptoms of hypocalcaemia. RESULTS: Transient symptomatic hypocalcaemia and persistent hypoparathyroidism occurred in 61 (15 per cent) and six (1.5 per cent) of 402 patients respectively. The intraoperative decline in PTH was 20.2 per cent; the trough (63.8 per cent of preoperative value) was reached 3 h after surgery. Before surgery, PTH levels were correlated inversely with serum Ca2+ concentration. The correlation remained positive from 3 h after surgery until postoperative day 14. Thus, PTH secretion was reduced, but remained sufficient to prevent symptomatic hypocalcaemia in most patients. A low serum PTH level was predictive of persistent hypoparathyroidism (sensitivity and negative predictive value 100 per cent, but poor specificity of 54.1 per cent). CONCLUSION: Thyroid surgery impairs hormone secretion by the parathyroid glands resulting in postoperative latent parathyroid insufficiency. Normal PTH levels 3 h after surgery and a normal serum calcium level on the first postoperative day rule out persistent hypoparathyroidism.
BACKGROUND: Hypocalcaemia after thyroidectomy is thought to result from surgical damage to the parathyroid glands. This study analysed postoperative outcomes related to perioperative parathyroid hormone (PTH) levels. METHODS: Some 402 consecutive patients undergoing thyroid surgery were studied prospectively to monitor perioperative changes in serum PTH and Ca2+ levels, and clinical symptoms of hypocalcaemia. RESULTS: Transient symptomatic hypocalcaemia and persistent hypoparathyroidism occurred in 61 (15 per cent) and six (1.5 per cent) of 402 patients respectively. The intraoperative decline in PTH was 20.2 per cent; the trough (63.8 per cent of preoperative value) was reached 3 h after surgery. Before surgery, PTH levels were correlated inversely with serum Ca2+ concentration. The correlation remained positive from 3 h after surgery until postoperative day 14. Thus, PTH secretion was reduced, but remained sufficient to prevent symptomatic hypocalcaemia in most patients. A low serum PTH level was predictive of persistent hypoparathyroidism (sensitivity and negative predictive value 100 per cent, but poor specificity of 54.1 per cent). CONCLUSION: Thyroid surgery impairs hormone secretion by the parathyroid glands resulting in postoperative latent parathyroid insufficiency. Normal PTH levels 3 h after surgery and a normal serum calcium level on the first postoperative day rule out persistent hypoparathyroidism.
Authors: Regina Promberger; Johannes Ott; Claudia Bures; Michael Freissmuth; Rudolf Seemann; Michael Hermann Journal: Endocrine Date: 2014-05-25 Impact factor: 3.633
Authors: Thomas J Musholt; Thomas Clerici; Henning Dralle; Andreja Frilling; Peter E Goretzki; Michael M Hermann; Jochen Kussmann; Kerstin Lorenz; Christoph Nies; Jochen Schabram; Peter Schabram; Christian Scheuba; Dietmar Simon; Thomas Steinmüller; Arnold W Trupka; Robert A Wahl; Andreas Zielke; Andreas Bockisch; Wolfram Karges; Markus Luster; Kurt W Schmid Journal: Langenbecks Arch Surg Date: 2011-03-22 Impact factor: 3.445
Authors: Johannes Ott; Klaus Mayerhofer; Kazem Nouri; Katharina Walch; Rudolf Seemann; Christine Kurz Journal: Endocrine Date: 2014-04-17 Impact factor: 3.633