Early Post-Op PTH Levels Predict Hypoparathyroidism Risk
In patients who underwent total thyroidectomy, parathyroid hormone (PTH) levels less than 10.10 pg/mL measured 6 hours after surgery helped accurately identify those at risk of developing transient and/or permanent hypoparathyroidism.
METHODOLOGY:
Transient and permanent hypoparathyroidism is a common complication of total thyroidectomy; accurately predicting which patients will develop the condition is essential for optimizing management, shortening hospital stays, and reducing health care costs.
Researchers conducted a prospective cohort study between September 2021 and November 2023 at a Spanish hospital to evaluate if a single PTH measurement 6 hours after total thyroidectomy could predict the risk for hypocalcemia and permanent hypoparathyroidism.
They analyzed data from 104 patients (mean age, 54.9 years; 80% women) who underwent first-time total thyroidectomy for multinodular goiter, Graves disease, or thyroid cancer or who underwent completion thyroidectomy and were followed up from the immediate postsurgical period through 12 months.
PTH was measured at 6 hours post-surgery, and protein-corrected serum calcium levels were measured at 24 and 48 hours post-surgery.
Transient hypoparathyroidism was defined by a corrected serum calcium level < 8 mg/dL accompanied by the need for calcium supplementation during the hospital stay and at discharge; permanent hypoparathyroidism was defined by either a corrected calcium level < 8 mg/dL or a PTH level < 15 pg/mL at 12 months.
TAKEAWAY:
Transient hypoparathyroidism occurred in 26.7% of patients, and permanent hypoparathyroidism occurred in 15.4%. Affected patients had significantly lower calcium levels at 24 and 48 hours and lower PTH levels at 6 hours than those without hypoparathyroidism (P < .05 for all).
PTH levels < 10.10 pg/mL at 6 hours post-surgery helped identify patients who developed transient hypoparathyroidism (area under the curve [AUC], 0.991; 95% CI, 0.978-1.000) or permanent hypoparathyroidism (AUC, 0.961; 95% CI, 0.925-0.997).
Each unit increase in PTH levels at 6 hours was associated with a 38% lower risk for permanent hypoparathyroidism (odds ratio, 0.62; P = .001), indicating a protective effect.
IN PRACTICE:
'[The study] findings introduce an easily reproducible preventive protocol based on a single PTH determination in the immediate postsurgical period, enabling more effective monitoring of patients at high risk for hypocalcemia while potentially reducing hospitalization duration and associated healthcare costs,' the study authors concluded.
SOURCE:
This study was led by Ana Segarra-Balao, Department of Endocrinology and Nutrition, University Hospital of Jaén, Jaén, Spain. It was published online in the Journal of Clinical Endocrinology & Metabolism.
LIMITATIONS:
This study included a small sample size and was conducted at a single center. Establishing center-specific cutoffs and optimal timing for measuring PTH levels after surgery might require further standardization.
DISCLOSURES:
This study received no funding from any public or private entity. The authors reported having no relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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