Abdalla Y Bashir1, Ahmad N Al-Zubidie2, Mohammad A Bashir3, Aiman H Obed3, Rami K Zakarneh3, Hassan Z Ennab4, Omar M Abu-Hijleh5, Mohamed M El-Zaheri5, Ahmad A Bashir3. 1. Department of Surgery, Jordan Hospital, Amman, Jordan. Electronic address: aybashir@gmail.com. 2. Statistician, Urology resident at Penn State University, Pennsylvania, USA. Previously at Department of Surgery, Jordan Hospital Amman, Jordan; Department of Surgery, Jordan Hospital, Amman, Jordan. 3. Department of Surgery, Jordan Hospital, Amman, Jordan. 4. Department of Pathology, Jordan Hospital, Amman, Jordan. 5. Department of Endocrinology, Jordan Hospital, Amman, Jordan.
Abstract
OBJECTIVE: to define optimal iPTH cut-off threshold predictive of hypocalcemia after total thyroidectomy for safe effective post-operative management. METHODS: prospective single center study done in two phases. In phase I, predictors of symptomatic hypocalcemia were analyzed and the Receiver Operating Characteristic curve (ROC) was used to define the optimal iPTH cut-off threshold predictive of hypocalcemia. Phase II studied giving prompt prophylactic supplemental calcium and vitamin D to all patients who had iPTH level below the calculated threshold, while phase I patients were given prompt selective supplementation if they had post-operative hypocalcemia or symptoms. RESULTS: 353 patients were included, 175 in phase I and 178 in phase II. Univariate analysis of patients in phase I showed that postoperative iPTH was the only significant variable that can predict symptomatic hypocalcemia (P > 0.001). Using ROC curve and Youden index, the confirmed optimal cut-off threshold predictive of hypocalcemia was iPTH 19.95 pg/mL, with AUC of 0.903 (CI 0.852-0.954), 100% sensitivity and negative predictive value and highest Youden index while iPTH 15 pg/mL and iPTH 10 pg/mL were less optimal. Symptomatic hypocalcemia occurred in (30%) in phase I cohort who received selective supplementation, versus (3%) in phase II cohort who received prophylactic supplementation (p value 0.0003). Return to the emergency and need for IV calcium were also significantly better in phase II (P=0.01). CONCLUSION: iPTH cut-off for post-thyroidectomy hypocalcemia was 19.95pg/mL. Low-risk patients were discharged with no supplementation while all high-risk patients received prompt calcium and vitamin D supplementation, which led to effective hypocalcemia management and safe 24-hour discharge.
OBJECTIVE: to define optimal iPTH cut-off threshold predictive of hypocalcemia after total thyroidectomy for safe effective post-operative management. METHODS: prospective single center study done in two phases. In phase I, predictors of symptomatic hypocalcemia were analyzed and the Receiver Operating Characteristic curve (ROC) was used to define the optimal iPTH cut-off threshold predictive of hypocalcemia. Phase II studied giving prompt prophylactic supplemental calcium and vitamin D to all patients who had iPTH level below the calculated threshold, while phase I patients were given prompt selective supplementation if they had post-operative hypocalcemia or symptoms. RESULTS: 353 patients were included, 175 in phase I and 178 in phase II. Univariate analysis of patients in phase I showed that postoperative iPTH was the only significant variable that can predict symptomatic hypocalcemia (P > 0.001). Using ROC curve and Youden index, the confirmed optimal cut-off threshold predictive of hypocalcemia was iPTH 19.95 pg/mL, with AUC of 0.903 (CI 0.852-0.954), 100% sensitivity and negative predictive value and highest Youden index while iPTH 15 pg/mL and iPTH 10 pg/mL were less optimal. Symptomatic hypocalcemia occurred in (30%) in phase I cohort who received selective supplementation, versus (3%) in phase II cohort who received prophylactic supplementation (p value 0.0003). Return to the emergency and need for IV calcium were also significantly better in phase II (P=0.01). CONCLUSION:iPTH cut-off for post-thyroidectomy hypocalcemia was 19.95pg/mL. Low-risk patients were discharged with no supplementation while all high-risk patients received prompt calcium and vitamin D supplementation, which led to effective hypocalcemia management and safe 24-hour discharge.
Authors: Kathrin Nagel; Anne Hendricks; Christina Lenschow; Michael Meir; Stefanie Hahner; Martin Fassnacht; Armin Wiegering; Christoph-Thomas Germer; Nicolas Schlegel Journal: BJS Open Date: 2022-09-02