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Open Access
CC BY 4.0 · Int Arch Otorhinolaryngol 2024; 28(01): e12-e21
DOI: 10.1055/s-0043-1777450
Original Research

Assessing Symptomatic Hypocalcemia Risk After Total Thyroidectomy: A Prospective Study

Autoren

  • Andro Košec 

    1   Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Centre “Sestre milosrdnice,” Zagreb, Croatia
    2   School of Medicine, University of Zagreb, Zagreb, Croatia

  • Ana Gašić

    2   School of Medicine, University of Zagreb, Zagreb, Croatia

  • Filip Hergešić

    2   School of Medicine, University of Zagreb, Zagreb, Croatia

  • Ivan Rašić

    1   Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Centre “Sestre milosrdnice,” Zagreb, Croatia
    2   School of Medicine, University of Zagreb, Zagreb, Croatia

  • Vesna Košec

    3   Department of Gynecology and Obstetrics, University Hospital Centre “Sestre milosrdnice,” Zagreb, Croatia

  • Vladimir Bedeković

    1   Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Centre “Sestre milosrdnice,” Zagreb, Croatia
    2   School of Medicine, University of Zagreb, Zagreb, Croatia

Funding This study was not funded by public or private institutions or individuals. Trial Registration NCT04304573, 03/26/2020.
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Abstract

Introduction The most common postoperative complication of total thyroidectomy is hypocalcemia, usually monitored using serum parathyroid hormone and calcium values.

Objective To identify the most accurate predictors of hypocalcemia, construct a risk assesment algorithm and analyze the impact of using several calcium correction formulas in practice.

Methods A prospective, single-center, non-randomized longitudinal cohort study on 205 patients undergoing total thyroidectomy. Parathyroid hormone, serum, and ionized calcium were sampled post-surgery, with the presence of symptomatic or laboratory-verified asymptomatic hypocalcemia designated as primary outcome measures.

Results Parathyroid hormone sampled on the first postoperative day was the most sensitive predictor of symptomatic hypocalcemia development (sensitivity 80.22%, cut-off value ≤2.03 pmol/L). A combination of serum calcium and parathyroid concentration sampled on the first postoperative day predicted the development of hypocalcemia during recovery with the highest sensitivity and specificity (94% sensitivity, cut-off ≤2.1 mmol/L, and 89% specificity, cut-off ≤1.55 pmol/L, respectively). The use of algorithms and correction formulas did not improve the accuracy of predicting symptomatic or asymptomatic hypocalcemia.

Conclusions The most sensitive predictor of symptomatic hypocalcemia present on the fifth postoperative day was PTH sampled on the first postoperative day. The need for algorithms and correction formulas is limited.

Keywords

calcium - hypocalcemia - parathyroid hormone - total thyroidectomy - risk assessment

Author Contribution Statement

AK, AG, FH, IR, VK, and VB all contributed to conceptualization, methodology, software, data curation, and writing-original draft preparation. AK, AG, and FH were involved with visualization, investigation, supervision, software, validation, and writing-reviewing and editing.


Disclosure Statement

The authors have stated that there are no conflicts of interest in connection with this article.


Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.


Ethics Approval

The study was approved by the Hospital Ethics Committee (EP-12939 / 18–17), following the International Conference on Harmonization principles and the Declaration of Helsinki. The study was pre-registered in the ClinicalTrials.gov online database.


Consent to Participate

Written informed consent was obtained from all participants.


Consent for Publication

All participants and authors gave their written consent for publication.




Publikationsverlauf

Eingereicht: 09. Oktober 2021

Angenommen: 05. Juni 2022

Artikel online veröffentlicht:
05. Februar 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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