Role of Intact Parathyroid Hormone Level as an Early Predictor of Postoperative Hypocalcemia after Total Thyroidectomy for Simple Multi-Nodular Goiter

Abstract

SUMMARY B ackground: Postoperative hypocalcaemia, secondary to hypoparathyroidism, is the most common complication observed in patients who undergo bilateral thyroid resection. Although hypocalcaemia is self-limiting in most patients and does not require treatment, symptomatic hypocalcaemia is of particular concern. We aimed to evaluate the accuracy of percentage decline of PTH measured 24 hours after thyroidectomy to predict postoperative serum calcium levels and can identify patients at risk of postoperative hypocalcaemia who require supplementation treatment, and those not at risk who can be safely discharged without any supplementation treatment. Moreover, combining postoperative PTH and serum calcium levels could result in an accurate prediction of the risk of postoperative hypocalcaemia. Methods: prospective analysis of 50 patients undergoing total thyroidectomy for simple mulinodular goiter. Preservation of parathyroid glands and their blood supply was attempted in all cases. The patients were assessed for manifestations of hypoparathyroidism after thyroidectomy. The assessment was done through: (1) monitoring the PTH level 24 hours postoperatively, (2) serum total calcium level was measured in the morning of postoperative day one, (3) clinical examination and detection of symptoms and signs of hypocalcemia.