A Single Parathyroid Hormone Level Obtained 4 Hours after Total Thyroidectomy Predicts the Need for Postoperative Calcium Supplementation

作者：Carr Azadeh A; Yen Tina W; Fareau Gilbert G; Cayo Ashley K; Misustin Sarah M; Evans Douglas B; Wang Tracy S^*

来源：Journal of the American College of Surgeons, 2014, 219(4): 757-764.

DOI：10.1016/j.jamcollsurg.2014.06.003

BACKGROUND: Parathyroid hormone (PTH) levels after total thyroidectomy have been shown to predict the development of symptomatic hypocalcemia and the need for calcium supplementation. This study aimed to determine whether a PTH level drawn 4 hours postoperatively is as effective as a level drawn on postoperative day 1 (POD1) in predicting this need. %26lt;br%26gt;STUDY DESIGN: This is a single-institution retrospective review of 4-hour and POD1 PTH levels in patients who underwent total thyroidectomy from January 2012 to September 2012. If POD1 PTH was %26gt;= 10 pg/mL, patients did not routinely receive supplementation; if PTH was %26lt;10 pg/mL, patients received oral calcium with or without calcitriol. %26lt;br%26gt;RESULTS: Of 77 patients, 20 (26%) had a 4-hour PTH %26lt;10 pg/mL; 18 (90%) of these patients had a POD1 PTH %26lt;10 pg/mL. No patient with a 4-hour PTH %26gt;= 10 pg/mL had a POD1 PTH %26lt;10 pg/mL. All 18 patients with POD1 PTH %26lt;10 pg/mL received calcium supplementation. Three additional patients received supplementation due to reported symptoms or surgeon preference. A 4-hour PTH %26gt;= 10 pg/mL compared with a POD1 PTH had a similar ability to predict which patients would not need calcium supplementation; sensitivity was 98% vs 98%, specificity was 90% vs 86%, and and negative predictive value was 95% vs 95%. Of 21 patients who received supplementation, 13 (62%) also received calcitriol, including 9 patients (69%) with a 4-hour PTH %26lt;6 pg/mL. %26lt;br%26gt;CONCLUSIONS: A single PTH level obtained 4 hours after total thyroidectomy that is %26gt;= 10 pg/mL accurately identifies patients who do not need calcium supplementation or additional monitoring of serum calcium levels. Same-day discharge, if deemed safe, can be accomplished with or without calcium supplementation based on the 4-hour PTH level. Greater consideration should be given to calcitriol supplementation in patients with a 4-hour PTH %26lt;6 pg/mL.

• 出版日期2014-10