The Prediction of Low Four-Hour Parathyroid Hormone Level After Total Thyroidectomy on Hypocalcemia
Keywords:
Postoperative hypoparathyroid, Postoperative hypocalcemiaAbstract
Objective: The purpose of the study is to study parathyroid hormone (PTH) level in prediction of early post-thyroidectomy hypocalcemia and long term hypoparathyroidism or hypocalcemia outcome six months after surgery.
Method: Patients who underwent total thyroidectomy or completion thyroidectomy procedure from July 2015 to July 2018 were studied. Corrected serum calcium and PTH levels were measured 4-hour after thyroidectomy and monitored from 24 to 48 hours. The levels of PTH and calcium were graded as normal or low levels. These data were analyzed using validation tools; sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.
Result: Out of a total of 66 patients, 24 cases were detected with low PTH levels after total thyroidectomy. The sensitivity and specificity of low PTH levels in the prediction of hypocalcemia were 45% and 79%, respectively, with a 79% positive predictive value and 58% accuracy. Prediction of permanent hypoparathyroidism after total thyroidectomy was with 53% sensitivity, 81% specificity and 66% accuracy.
Conclusion: The low PTH levels may be an indicator of hypocalcemia after total thyroidectomy, in which the evidence shows high specificity and positive predictive value. Therefore, if hypoparathyroidism is detected after total thyroidectomy, hypocalcemia is high likely, so calcium or vitamin D replacement should be provided to prevent severe hypocalcemia.
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