Annals of Surgical Oncology

, Volume 18, Issue 3, pp 777–781 | Cite as

The Value of Postoperative Parathyroid Hormone Levels in Predicting the Need for Long-Term Vitamin D Supplementation after Total Thyroidectomy

  • Tracy S. Wang
  • Ashley K. Cayo
  • Stuart D. Wilson
  • Tina W. F. Yen
Endocrine Tumors

Abstract

Background

Few studies have examined the need for vitamin D supplementation after total thyroidectomy. This study examines the role of postoperative day (POD) 1 serum calcium and parathyroid hormone (PTH) levels in predicting the need for long-term vitamin D supplementation after total thyroidectomy.

Methods

A retrospective, single institutional study of patients who underwent total thyroidectomy between January 2007 and December 2008 was performed. Data collected included extent of surgery, final pathology, postoperative calcium (mg/dl) and PTH (pg/ml) values, and duration of vitamin D supplementation. Patients were divided into 4 groups based on POD1 PTH values: group 1 (<5.0); group 2 (5.0–10); group 3 (10.1–20); and group 4 (>20).

Results

Of the 104 patients, 26 were in group 1, 12 in group 2, 18 in group 3, and 48 in group 4, with median PTH values of <2.5, 8.2, 14.1, and 30 pg/ml, respectively. All 7 (7%) patients who required vitamin D supplementation >1 month were in group 1. The positive predictive value of POD1 PTH <5.0 in predicting supplementation >1 month was 27% (sensitivity 100%, specificity 80%). Seventy-eight patients had a POD1 PTH level ≥5, and none required vitamin D supplementation >1 month (100% negative predictive value). The positive predictive value of various POD1 calcium thresholds (<7.5, <8.0, and <8.5 mg/dl) was 17, 14, and 15%, respectively.

Conclusions

Postoperative PTH levels better predict long-term hypocalcemia requiring vitamin D supplementation than serum calcium levels. A PTH level ≥5.0 may identify patients who can be safely discharged without routine vitamin D supplementation.

Keywords

Total Thyroidectomy Central Neck Dissection Postoperative Hypocalcemia Lateral Neck Dissection Oral Calcium Supplementation 

Notes

Conflict of interest

All authors have nothing to disclose.

References

  1. 1.
    Asari R, Passler C, Kaczirek K, Scheuba C, Niederle B. Hypoparathyroidism after total thyroidectomy: a prospective study. Arch Surg. 2008;143:132–7; discussion 138.PubMedCrossRefGoogle Scholar
  2. 2.
    McHenry CR, Speroff T, Wentworth D, Murphy T. Risk factors for postthyroidectomy hypocalcemia. Surgery. 1994;116:641–7; discussion 647–8.PubMedGoogle Scholar
  3. 3.
    Pattou F, Combemale F, Fabre S, et al. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg. 1998;22:718–24.PubMedCrossRefGoogle Scholar
  4. 4.
    Erbil Y, Bozbora A, Ozbey N, Issever H, Aral F, Ozarmagan S, Tezelman, S. Predictive value of age and serum parathormone and vitamin d3 levels for postoperative hypocalcemia after total thyroidectomy for nontoxic multinodular goiter. Arch Surg. 2007;142:1182–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Sywak MS, Palazzo FF, Yeh MW, WIlkinson M, Snook K, Sidhu SB, Delbridge LW. Parathyroid hormone assay predicts hypocalcaemia after total thyroidectomy. ANZ J Surg. 2007;77:667–70.PubMedCrossRefGoogle Scholar
  6. 6.
    Walker Harris V, Jan De Beur S. Postoperative hypoparathyroidism: medical and surgical therapeutic options. Thyroid. 2009;19:967–73.PubMedCrossRefGoogle Scholar
  7. 7.
    White ML, Gauger PG, Doherty GM. Central lymph node dissection in differentiated thyroid cancer. World J Surg. 2007;31:895–904.PubMedCrossRefGoogle Scholar
  8. 8.
    Moore FD, Jr. Oral calcium supplements to enhance early hospital discharge after bilateral surgical treatment of the thyroid gland or exploration of the parathyroid glands. J Am Coll Surg. 1994;178:11–6.PubMedGoogle Scholar
  9. 9.
    Bellantone R, Lombardi CP, Raffaelli M, et al. Is routine supplementation therapy (calcium and vitamin D) useful after total thyroidectomy? Surgery. 2002;132:1109–12.PubMedCrossRefGoogle Scholar
  10. 10.
    Roh JL, Park JY, Park CI. Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection. Cancer. 2009;115:251–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Payne RJ, Tewfik MA, Hier MP, Tamilia M, MacNamara E, Young J, Black MJ. Benefits resulting from 1- and 6-hour parathyroid hormone and calcium levels after thyroidectomy. Otolaryngol Head Neck Surg. 2005;133:386–90.PubMedCrossRefGoogle Scholar
  12. 12.
    Lombardi CP, Raffaelli M, Princi P, et al. Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurement. Surgery. 2004;136:1236–41.PubMedCrossRefGoogle Scholar
  13. 13.
    Soon PS, Magarey CJ, Campbell P, Jalaludin B. Serum intact parathyroid hormone as a predictor of hypocalcaemia after total thyroidectomy. ANZ J Surg. 2005;75:977–80.PubMedCrossRefGoogle Scholar
  14. 14.
    Australian Endocrine Surgeons Guidelines AES06/01. Postoperative parathyroid hormone measurement and early discharge after total thyroidectomy: analysis of Australian data and management recommendations. ANZ J Surg. 2007;77:199–202.Google Scholar
  15. 15.
    de Andrade Sousa A, Salles JM, Soares JM, de Moraes GM, Carvalho JR, Rocha PR. Course of ionized calcium after thyroidectomy. World J Surg. 2010;34:987–92.PubMedCrossRefGoogle Scholar
  16. 16.
    Hermann M, Ott J, Promberger R, Kober F, Karik M, Fressmuth M. Kinetics of serum parathyroid hormone during and after thyroid surgery. Br J Surg. 2008;95:1480–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Youngwirth L, Benavidez J, Sippel R, Chen H. Parathyroid hormone deficiency after total thyroidectomy: incidence and time. J Surg Res. 2010;163:69–71.PubMedCrossRefGoogle Scholar
  18. 18.
    Abboud B, Sargi Z, Akkam M, Sleilaty F. Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg. 2002;195:456–61.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Tracy S. Wang
    • 1
  • Ashley K. Cayo
    • 1
  • Stuart D. Wilson
    • 1
  • Tina W. F. Yen
    • 1
  1. 1.Division of Surgical Oncology, Department of SurgeryMedical College of WisconsinMilwaukeeUSA

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