Abstract
Postoperative hypocalcaemia is the most frequent and common complication after total thyroidectomy. It is necessary to diagnose or to predict hypocalcaemia immediately after total thyroidectomy for minimizing complications. A prospective observational study was carried out in the Department of Clinical Pathology in collaboration with Department of Microbiology & Immunology, Department of Surgery, Department of Otolaryngology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Department of Otolaryngology, Dhaka Medical College & Hospital (DMC&H), Dhaka, during the period of September 2010 to August 2011 to evaluate intraoperative (20 minutes after total thyroidectomy) parathyroid hormone (PTH) measurement as a predictor of post thyroidectomy hypocalcaemia. Total 65 patients were enrolled in this study those came for total thyroidectomy. Postoperative hypocalcaemia developed in 25 cases. Intraoperative PTH was assessed and significant correlation was found between intraoperative PTH level and development of hypocalcaemia. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of intraoperative serum PTH for prediction of post total thyroidectomy hypocalcaemia were 84.0%, 85.0%, 84.6%, 77.8%, and 89.5% respectively. Because of the high sensitivity, specificity and accuracy of intraoperative serum PTH of this study, the early prediction of hypocalcaemia could be made by single assay of intraoperative serum PTH level at 20 minutes after total thyroidectomy.
Highlights
Total thyroidectomy is generally done for patients with thyroid malignancy, thyrotoxicosis or toxic multinodular goiter and for chronic thyroiditis[1].Total thyroidectomy is associated with specific complications namely, haemorrhage/haematoma, recurrent laryngeal nerve injury[2] and hypoparathyroidism with subsequent hypocalcaemia[3].Post thyroidectomy hypocalcaemia develops as a result of hypoparathyroidism secondary to parathyroid trauma, devascularization or inadvertent removal of parathyroid gland during thyroid surgery[4]
The aim of this study is to evaluate intraoperative parathyroid hormone (PTH) measurement and to predict post thyroidectomy hypocalcaemia accurately
To focus our study on hypocalcaemia, we considered as hypocalcaemic patients only with a serum calcium level
Summary
Total thyroidectomy is associated with specific complications namely, haemorrhage/haematoma, recurrent laryngeal nerve injury[2] and hypoparathyroidism with subsequent hypocalcaemia[3]. Post thyroidectomy hypocalcaemia develops as a result of hypoparathyroidism secondary to parathyroid trauma, devascularization or inadvertent removal of parathyroid gland during thyroid surgery[4]. Measurement of serum calcium cannot be used as a predictor of hypocalcaemia immediately after thyroid surgery[11]. Postoperative PTH levels less than 15 pg/ml on the first postoperative day are more sensitive for prediction of hypoparathyroidism[13]. This assay has been shown to accurately predict hypocalcaemia, following thyroid surgery[14]
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