演題

PROSPECTIVE EVALUATION OF INTRAOPERATIVE QUICK PARATHYROID HORMONE ASSAY AS AN EARLY PREDICTOR OF POST THYROIDECTOMY HYPOCALCEMIA

[演者] Ashwini Chinnama Reddy:1
[著者] Chand Gyan:1, Agarwal Amit:1
1:Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow

AIMS & OBJECTIVES: Hypocalcemia following total thyroidectomy is a major contributing factor in delayed hospital discharge and dissuading surgeons from day care thyroidectomy. We prospectively evaluated the utility of Intraoperative serum quick parathyroid hormone level measurement twenty minutes after total thyroidectomy in predicting post-operative hypocalcemia.METHODS: Prospective longitudinal study which included patients undergoing total thyroidectomy for benign or malignant thyroid disorders in SGPGIMS, Lucknow, India from Oct 2013 to Dec 2013. Patients who received calcium prophylaxis were excluded from the study. Intraoperative serum quick PTH level measurements were done 20 minutes after resection of thyroid. Serum calcium levels were estimated preoperatively and on three consecutive post operative days. Calcium supplementation were started in patients with symptomatic hypocalcemia.RESULTS: The study covered 32 patients with a mean age of 38 years, range 19-67 years. 18 patients had euthyroid multinodular goitre, 5 patients graves disease and 9 patients had differentiated thyroid cancer. Total thyroidectomy was performed in 26 patients, total thyroidectomy with lymph node dissection in 6 patients. Post-operatively 56% patients experienced symptomatic hypocalcemia. The IOPTH level of 11.5 pmol/L 20 minutes after total thyroidectomy, had the highest sensitivity and specificity of 86% and 67% respectively in predicting post-operative hypocalcemia.CONCLUSION: Parathyroid hormone assay twenty minutes after thyroidectomy is an accurate and reliable means of predicting clinically relevant hypocalcemia. Patients with PTH values more than 11.5 pmol/L twenty minutes after thyroidectomy can be safely discharged on the same postoperative day as the probability of life threatening hypocalcemia is unlikely.
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