Analía Verónica Freire1, María Gabriela Ropelato2, María Gabriela Ballerini2, Oscar Acha2, Ignacio Bergadá2, Laura Gruñeiro de Papendieck2, Ana Chiesa2. 1. Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET - FEI - División de Endocrinología, Hospital de Niños "Ricardo Gutiérrez", Buenos Aires, Argentina. Electronic address: afreire@cedie.org.ar. 2. Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET - FEI - División de Endocrinología, Hospital de Niños "Ricardo Gutiérrez", Buenos Aires, Argentina.
Abstract
BACKGROUND AND AIMS: Hypocalcemia after thyroidectomy is caused by parathyroid trauma. There are no studies regarding the usefulness of intact parathyroid hormone (PTH) as a monitor of postoperative hypoparathyroidism tool in pediatrics. We evaluated the diagnostic accuracy of intra- and postoperative PTH to predict the risk of developing post thyroidectomy hypocalcemia in children. METHODS: A prospective longitudinal cohort study was conducted in 32 pediatric patients (3.2-17.6 years old) undergoing total thyroidectomy. Intact PTH measured by the assays (Immulite Immunoassay System [ICMA] or electrochemioluminescence assay [ECLIA]) at 5 (PTH-5) and 60 (PTH-60) minutes after thyroid removal were considered as predicting variables. The postoperative outcome was hypocalcemia (endpoint variable). Patients were clinically and biochemically monitored regularly for 48 hours after surgery. RESULTS: Of the patients, 47% developed hypocalcemia (15% symptomatic). An ICMA PTH-5 of ≤14 pg/mL or an ECLIA PTH-5 of ≤16 pg/mL predicted hypocalcemia with a sensitivity of 80%, specificity of 100%, positive predictive value (PPV) of 100%, and diagnostic efficiency (DE) of 91%. Using the same cutoff values, PTH-60 presented a sensitivity of 93%, specificity of 82%, PPV of 81%, and DE of 87%. Adjusting for variation in the assays and combining intra- and postoperative PTH determinations, we developed an algorithm that improved sensitivity, specificity, and DE. CONCLUSION: PTH is useful for predicting hypocalcemia after total thyroidectomy in children. The use of our proposed strategy should be considered to (a) initiate preventive treatment in patients identified at high risk for hypocalcemia, (b) shorten the duration of hospitalization, and (c) reduce the clinical and biochemical controls in those who remained normocalcemic.
BACKGROUND AND AIMS: Hypocalcemia after thyroidectomy is caused by parathyroid trauma. There are no studies regarding the usefulness of intact parathyroid hormone (PTH) as a monitor of postoperative hypoparathyroidism tool in pediatrics. We evaluated the diagnostic accuracy of intra- and postoperative PTH to predict the risk of developing post thyroidectomy hypocalcemia in children. METHODS: A prospective longitudinal cohort study was conducted in 32 pediatric patients (3.2-17.6 years old) undergoing total thyroidectomy. Intact PTH measured by the assays (Immulite Immunoassay System [ICMA] or electrochemioluminescence assay [ECLIA]) at 5 (PTH-5) and 60 (PTH-60) minutes after thyroid removal were considered as predicting variables. The postoperative outcome was hypocalcemia (endpoint variable). Patients were clinically and biochemically monitored regularly for 48 hours after surgery. RESULTS: Of the patients, 47% developed hypocalcemia (15% symptomatic). An ICMA PTH-5 of ≤14 pg/mL or an ECLIA PTH-5 of ≤16 pg/mL predicted hypocalcemia with a sensitivity of 80%, specificity of 100%, positive predictive value (PPV) of 100%, and diagnostic efficiency (DE) of 91%. Using the same cutoff values, PTH-60 presented a sensitivity of 93%, specificity of 82%, PPV of 81%, and DE of 87%. Adjusting for variation in the assays and combining intra- and postoperative PTH determinations, we developed an algorithm that improved sensitivity, specificity, and DE. CONCLUSION:PTH is useful for predicting hypocalcemia after total thyroidectomy in children. The use of our proposed strategy should be considered to (a) initiate preventive treatment in patients identified at high risk for hypocalcemia, (b) shorten the duration of hospitalization, and (c) reduce the clinical and biochemical controls in those who remained normocalcemic.
Authors: Kristina Cossen; Matthew T Santore; Kara K Prickett; Steven L Goudy; Kurt F Heiss; Kanika Shanker; Adina L Alazraki; Briana C Patterson Journal: Pediatr Qual Saf Date: 2022-06-14
Authors: Sasha R Howard; Sarah Freeston; Barney Harrison; Louise Izatt; Sonali Natu; Kate Newbold; Sabine Pomplun; Helen A Spoudeas; Sophie Wilne; Tom R Kurzawinski; Mark N Gaze Journal: Endocr Relat Cancer Date: 2022-09-07 Impact factor: 5.900
Authors: Steven D Tsai; Sogol Mostoufi-Moab; Samantha Bauer; Ken Kazahaya; Colin P Hawkes; N Scott Adzick; Andrew J Bauer Journal: Front Endocrinol (Lausanne) Date: 2019-11-06 Impact factor: 5.555