Postoperative parathyroid hormone levels as a predictor for persistent hypoparathyroidism

in European Journal of Endocrinology
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  • 1 Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  • 2 Department of Surgery, ZGT Hospital, Almelo/Hengelo, The Netherlands
  • 3 Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
  • 4 Department of Psychiatry Section of Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  • 5 Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  • 6 Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
  • 7 Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
  • 8 Department of Clinical Chemistry, Reinier de Graaf Gasthuis, Delft, The Netherlands
  • 9 Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

Correspondence should be addressed to I Lončar; Email: i.loncar@erasmusmc.nl
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Objective

Hypoparathyroidism is a common complication after thyroidectomy. It is not yet possible to predict in which patients hypoparathyroidism will persist. We aim to determine whether a decrease in PTH levels, measured at the first postoperative day, can identify patients with a high risk for persistent hypoparathyroidism one year after thyroidectomy.

Design

Prospective multi-center cohort study.

Methods

Patients undergoing total or completion thyroidectomy were included. We measured PTH levels preoperatively and on the first postoperative day. Primary outcome is the proportion of patients with persistent hypoparathyroidism, defined as the need for calcium supplementation one year after surgery.

Results

We included 110 patients of which 81 were used for analysis of the primary outcome. At discharge 72.8% of patients were treated with calcium supplementation. Persistent hypoparathyroidism was present in 14 patients (17.3%) at one-year follow-up, all of them had a decrease in PTH >70% at the first postoperative day. These 14 were 43.8% of the 32 patients who had such a decrease. In the group of 49 patients (59.8%) without a PTH >70% decrease, none had persistent hypoparathyroidism one year after surgery (P-value <0.001). A decrease of >70% in PTH levels had a sensitivity of 100.0% (95% CI: 85.8–100.0%), a specificity of 73.1% (95% CI: 62.5–83.7%) and an area under the curve of 0.87 (95% CI: 0.79–0.94) to predict the risk for persistent hypoparathyroidism.

Conclusion

In our study a decrease in PTH levels of >70% after total or completion thyroidectomy is a reliable predictor for persistent hypoparathyroidism, and this should be confirmed in larger cohorts.

Supplementary Materials

    • Supplementary Table 1. Baseline characteristics of included and excluded cases

 

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