Giuseppe Mercante1,2, Andrea Anelli3, Diana Giannarelli4, Davide Giordano5, Ilenia Sinopoli3, Fabio Ferreli2, Giovanna Digiesi6, Maria L Appetecchia7, Agnese Barnabei7, Giovanni Cristalli3, Laura Conti6, Raul Pellini3, Fabio Piazza8, Davide Lombardi9, Armando De Virgilio1,2, Giuseppe Spriano1,2. 1. Department of Biomedical Sciences, Humanitas University, Milan, Italy. 2. Otorhinolaryngology Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy. 3. Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy. 4. Department of Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, Rome, Italy. 5. Otolaryngology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy. 6. Clinical Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy. 7. Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy. 8. Department of Otolaryngology-Head and Neck Surgery, "Carlo Poma" Civil Hospital, Mantua, Italy. 9. Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy.
Abstract
BACKGROUND: Three different strategies to manage transient hypocalcemia after total thyroidectomy were compared to evaluate cost-effectiveness. The reliability of total serum calcium (TSCa), ionized calcium (ICa), and intact parathyroid hormone (iPTH) were investigated to achieve this goal. METHODS: A multicenter, prospective randomized study was carried out with 169 patients. The strategies were "preventive" (oral calcium + vitamin D supplementation), "reactive" (therapy in hypocalcemia), and "predictive" (therapy if iPTH <10 pg/mL). RESULTS:TSCa had higher accuracy in identifying patients who developed hypocalcemia-related symptoms than ICa (84.6% vs 50.0%). TSCa 24 h after surgery showed 24.8% of patients with hypocalcemia, whereas TSCa 48 h after surgery identified a further 10.6% with hypocalcemia (only in the "reactive" and "predictive" groups). iPTH showed low sensitivity as a predictor of hypocalcemia. Between the 3 groups, there was no significant difference in hospitalization time or number of symptomatic hypocalcemic patients. Interestingly, the cost-per-patient was significantly different among the groups. CONCLUSIONS: None of the discussed strategies allowed for early discharge of patients without any risk of transient hypocalcemia. The "preventive" strategy was the most cost-effective, despite overtreatment.
RCT Entities:
BACKGROUND: Three different strategies to manage transient hypocalcemia after total thyroidectomy were compared to evaluate cost-effectiveness. The reliability of total serum calcium (TSCa), ionizedcalcium (ICa), and intact parathyroid hormone (iPTH) were investigated to achieve this goal. METHODS: A multicenter, prospective randomized study was carried out with 169 patients. The strategies were "preventive" (oral calcium + vitamin D supplementation), "reactive" (therapy in hypocalcemia), and "predictive" (therapy if iPTH <10 pg/mL). RESULTS: TSCa had higher accuracy in identifying patients who developed hypocalcemia-related symptoms than ICa (84.6% vs 50.0%). TSCa 24 h after surgery showed 24.8% of patients with hypocalcemia, whereas TSCa 48 h after surgery identified a further 10.6% with hypocalcemia (only in the "reactive" and "predictive" groups). iPTH showed low sensitivity as a predictor of hypocalcemia. Between the 3 groups, there was no significant difference in hospitalization time or number of symptomatic hypocalcemicpatients. Interestingly, the cost-per-patient was significantly different among the groups. CONCLUSIONS: None of the discussed strategies allowed for early discharge of patients without any risk of transient hypocalcemia. The "preventive" strategy was the most cost-effective, despite overtreatment.
Authors: S Mattoo; A Agarwal; S Mayilvaganan; P Mishra; G Agarwal; A Mishra; G Chand; S K Gupta; S K Mishra Journal: J Endocrinol Invest Date: 2021-01-27 Impact factor: 4.256