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array:24 [ "pii" => "S2173573511000251" "issn" => "21735735" "doi" => "10.1016/j.otoeng.2011.01.002" "estado" => "S300" "fechaPublicacion" => "2011-07-01" "aid" => "266" "copyright" => "Elsevier España, S.L.. All rights reserved" "copyrightAnyo" => "2010" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Acta Otorrinolaringol Esp. 2011;62:265-73" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3700 "formatos" => array:3 [ "EPUB" => 48 "HTML" => 2746 "PDF" => 906 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001651911000197" "issn" => "00016519" "doi" => "10.1016/j.otorri.2011.01.007" "estado" => "S300" "fechaPublicacion" => "2011-07-01" "aid" => "266" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Acta Otorrinolaringol Esp. 2011;62:265-73" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 9695 "formatos" => array:3 [ "EPUB" => 68 "HTML" => 7658 "PDF" => 1969 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artículo original</span>" "titulo" => "Valor predictivo de la paratohormona en la hipocalcemia postiroidectomía" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "265" "paginaFinal" => "273" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Parathyroid hormone as a predictor of post-thyroidectomy hypocalcemia" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1458 "Ancho" => 2910 "Tamanyo" => 210648 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Diagnósticos preoperatorios y anatomopatológicos de los 108 pacientes intervenidos. Ca: carcinoma.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Laura Del Río, Alejandro Castro, Ricardo Bernáldez, Antonio Del Palacio, Carolina V. Giráldez, Beatriz Lecumberri, Cristina Álvarez-Escolá, Alberto Fernández-Martínez" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Laura" "apellidos" => "Del Río" ] 1 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Castro" ] 2 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Bernáldez" ] 3 => array:2 [ "nombre" => "Antonio" "apellidos" => "Del Palacio" ] 4 => array:2 [ "nombre" => "Carolina V." "apellidos" => "Giráldez" ] 5 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Lecumberri" ] 6 => array:2 [ "nombre" => "Cristina" "apellidos" => "Álvarez-Escolá" ] 7 => array:2 [ "nombre" => "Alberto" "apellidos" => "Fernández-Martínez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173573511000251" "doi" => "10.1016/j.otoeng.2011.01.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573511000251?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651911000197?idApp=UINPBA00004N" "url" => "/00016519/0000006200000004/v1_201304231434/S0001651911000197/v1_201304231434/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173573511000238" "issn" => "21735735" "doi" => "10.1016/j.otoeng.2011.01.001" "estado" => "S300" "fechaPublicacion" => "2011-07-01" "aid" => "268" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Acta Otorrinolaringol Esp. 2011;62:274-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5961 "formatos" => array:3 [ "EPUB" => 49 "HTML" => 4920 "PDF" => 992 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Sphenopalatinum Foramen: An Anatomical Study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "274" "paginaFinal" => "278" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio anatómico del orificio esfenopalatino" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 694 "Ancho" => 1001 "Tamanyo" => 171472 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Sphenopalatine foramen between the superior and middle meatus.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Silvia Herrera Tolosana, Rafael Fernández Liesa, Juan de Dios Escolar Castellón, Laura Pérez Delgado, María Pilar Lisbona Alquezar, Gloria Tejero-Garcés Galve, María Guallar Larpa, Alberto Ortiz García" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Silvia" "apellidos" => "Herrera Tolosana" ] 1 => array:2 [ "nombre" => "Rafael" "apellidos" => "Fernández Liesa" ] 2 => array:2 [ "nombre" => "Juan de Dios" "apellidos" => "Escolar Castellón" ] 3 => array:2 [ "nombre" => "Laura" "apellidos" => "Pérez Delgado" ] 4 => array:2 [ "nombre" => "María Pilar" "apellidos" => "Lisbona Alquezar" ] 5 => array:2 [ "nombre" => "Gloria" "apellidos" => "Tejero-Garcés Galve" ] 6 => array:2 [ "nombre" => "María" "apellidos" => "Guallar Larpa" ] 7 => array:2 [ "nombre" => "Alberto" "apellidos" => "Ortiz García" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001651911000215" "doi" => "10.1016/j.otorri.2011.01.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651911000215?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573511000238?idApp=UINPBA00004N" "url" => "/21735735/0000006200000004/v1_201304231458/S2173573511000238/v1_201304231458/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173573511000305" "issn" => "21735735" "doi" => "10.1016/j.otoeng.2010.12.005" "estado" => "S300" "fechaPublicacion" => "2011-07-01" "aid" => "260" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Acta Otorrinolaringol Esp. 2011;62:255-64" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4381 "formatos" => array:3 [ "EPUB" => 53 "HTML" => 3205 "PDF" => 1123 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Alterations in Voice, Speech and Swallowing in Patients With Sjögren's Syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "255" "paginaFinal" => "264" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Alteraciones de la voz, el habla y la deglución en pacientes con síndrome de Sjögren" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 4271 "Ancho" => 3014 "Tamanyo" => 949968 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Spectrogram and oscillogram of patients with alterations in voice and speech. (a) 4 first formants of the vowel /a/, showing irregularity of the morphology with all formants. (b) Broadband spectrogram of the vowel /o/, showing the aperiodic segment. (c) Normal plot in the oscillogram of the trisyllable /pataka/. (d) Abnormal plot in the oscillogram of the trisyllable /pataka/, where the downwards arrows show the segments with rhythm alterations. (e) Broadband spectrogram of the trisyllable /pataka/ analysed in the upper oscillogram, indicating the aperiodic segments.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Laura Daniela Ruiz Allec, Xochiquetzal Hernández López, Juanita Beatriz Arreguín Porras, Regina Velasco Ramos, Julia Cristina Pacheco del Valle, Ángel Israel Pérez García" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Laura Daniela" "apellidos" => "Ruiz Allec" ] 1 => array:2 [ "nombre" => "Xochiquetzal" "apellidos" => "Hernández López" ] 2 => array:2 [ "nombre" => "Juanita Beatriz" "apellidos" => "Arreguín Porras" ] 3 => array:2 [ "nombre" => "Regina" "apellidos" => "Velasco Ramos" ] 4 => array:2 [ "nombre" => "Julia Cristina" "apellidos" => "Pacheco del Valle" ] 5 => array:2 [ "nombre" => "Ángel Israel" "apellidos" => "Pérez García" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001651911000082" "doi" => "10.1016/j.otorri.2010.12.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651911000082?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573511000305?idApp=UINPBA00004N" "url" => "/21735735/0000006200000004/v1_201304231458/S2173573511000305/v1_201304231458/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Parathyroid Hormone as a Predictor of Post-Thyroidectomy Hypocalcemia" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "265" "paginaFinal" => "273" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Laura Del Río, Alejandro Castro, Ricardo Bernáldez, Antonio Del Palacio, Carolina V. Giráldez, Beatriz Lecumberri, Cristina Álvarez-Escolá, Alberto Fernández-Martínez" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Laura" "apellidos" => "Del Río" "email" => array:1 [ 0 => "lauradelrioarroyo@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Alejandro" "apellidos" => "Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Ricardo" "apellidos" => "Bernáldez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Antonio" "apellidos" => "Del Palacio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Carolina V." "apellidos" => "Giráldez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Beatriz" "apellidos" => "Lecumberri" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "Cristina" "apellidos" => "Álvarez-Escolá" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 7 => array:3 [ "nombre" => "Alberto" "apellidos" => "Fernández-Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Bioestadística, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Endocrinología, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Valor predictivo de la paratohormona en la hipocalcemia postiroidectomía" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1472 "Ancho" => 2917 "Tamanyo" => 249420 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Protocol for treatment of hypocalcaemia after thyroidectomy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Hypocalcaemia is one of the most common complications of total thyroidectomy. Its incidence in the literature ranges between 1% and 50%. Most authors report an incidence of 20%–30%, with symptoms ranging from numbness to tetany. Postoperative hypocalcaemia is usually temporary, with an incidence of permanent hypocalcaemia of about 2%.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Although its aetiology is often multifactorial, most cases of hypocalcaemia are due to hyperparathyroidism as a result of the accidental removal, injury or devascularization of the parathyroid glands during surgery. While other possible complications of thyroidectomy, such as recurrent paralysis, laryngeal oedema or cervical haematoma, usually appear within the first 24<span class="elsevierStyleHsp" style=""></span>h after surgery, the nadir of hypocalcaemia typically occurs at 24–48<span class="elsevierStyleHsp" style=""></span>h after surgery. Occasionally, it may be delayed until the fourth postoperative day. This delay in the manifestation of hypocalcaemia is the reason why hospital stay after total thyroidectomy lasts longer than 24<span class="elsevierStyleHsp" style=""></span>h, to prevent possible complications of late-onset hypocalcaemia.Several strategies have been proposed in the literature to diagnose and treat hypocalcaemia. The traditional method, consisting of serializing serum calcium levels during a hospital stay of 48<span class="elsevierStyleHsp" style=""></span>h, is still used in many hospitals around the world,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> including ours. Some surgeons advocate routine administration of oral calcium and/or vitamin D to all patients<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> so as to shorten hospital stay with a minimal risk of hypocalcaemia upon discharge. In recent years, there have been several studies suggesting the determination of postoperative parathyroid hormone (PTH) for early prediction of the risk of hypocalcaemia.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,6–9</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although many authors advocate using of PTH to predict hypocalcaemia, others recommend abandoning its use.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–12</span></a> Attempting to clarify this controversy, Grodski et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> conducted a review of the English literature on the accuracy of PTH in predicting hypocalcaemia after thyroidectomy, the optimal time to determine postoperative PTH and the role of routine use of oral calcium supplements. They found that levels of PTH after thyroidectomy could predict the development of hypocalcaemia, but lacked 100% accuracy. They concluded that, since it is unlikely that patients with a normal postoperative level of PTH develop hypocalcaemia, PTH could be used with caution to plan discharge 24<span class="elsevierStyleHsp" style=""></span>h after surgery in many cases. In addition, PTH determination could be used to assess the desirability of establishing early therapy with calcium and/or vitamin D for patients at risk of developing hypocalcaemia, to reduce its incidence and severity (grade C recommendation).</p><p id="par0015" class="elsevierStylePara elsevierViewall">The hypothesis of our study was that, using the determination of intact PTH, patients could be classified into 3 groups:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Patients at minimal risk of hypocalcaemia:</span> could be discharged 24<span class="elsevierStyleHsp" style=""></span>h after surgery, avoiding an unnecessary extension of hospital stay.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Patients at high risk of hypocalcaemia:</span> would initiate treatment with calcium supplements before the onset of symptoms, thus preventing the development of a potentially deadly condition.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Patients at intermediate risk of hypocalcaemia:</span> would be admitted for 48 h, following the standard procedure for the detection and treatment of hypocalcaemia.</p></li></ul></p><p id="par0035" class="elsevierStylePara elsevierViewall">There is no consensus in the literature about the cut-off values of serum calcium, intact PTH, and decrease in PTH levels to predict hypocalcaemia. In fact, normal ranges vary depending on each laboratory and each institution must establish its own references for intact PTH and the predictive value of such determination before generalising its use in daily clinical practice. This is the reason why we designed, in collaboration with the Department of Endocrinology and Biochemistry and the Biostatistics Unit, a prospective study to validate the technique and calculate our own reference values.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The main objective of this study was to establish the optimal time for sample extraction of intact PTH and the best cut-off points for the decline in PTH levels, to stratify patients according to their risk of developing hypocalcaemia, and act accordingly.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Methods</span><p id="par0045" class="elsevierStylePara elsevierViewall">We recruited all patients who underwent total thyroidectomy in 1 or 2 stages at the ENT Department of our hospital between 1 February 2009 and 1 March 2010. The study was reviewed and approved by the Ethics Committee of the Centre. All participants signed a specific consent prior to their enrolment in the study.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The exclusion criteria for patients were:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1.</span><p id="par0055" class="elsevierStylePara elsevierViewall">Preoperative alterations in parathyroid gland function.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2.</span><p id="par0060" class="elsevierStylePara elsevierViewall">Severe chronic renal insufficiency (defined as serum creatinine >2<span class="elsevierStyleHsp" style=""></span>mg/dl or creatinine clearance <40<span class="elsevierStyleHsp" style=""></span>ml/min).</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3.</span><p id="par0065" class="elsevierStylePara elsevierViewall">Diseases or treatments that interfered with calcium homeostasis (bisphosphonates, diuretics, lithium, anticonvulsants, etc.).</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">4.</span><p id="par0070" class="elsevierStylePara elsevierViewall">Lack of any analytical determination from those used in the study.</p></li></ul></p><p id="par0075" class="elsevierStylePara elsevierViewall">We recorded age, gender, preoperative endocrine diagnosis, type of surgery (total thyroidectomy in 1 or 2 stages), the number of parathyroid glands preserved or transplanted in the operation, the presence of symptoms and signs of hypocalcaemia (Chvostek's and Trousseau's signs) in the postoperative period, the need for administration or not of parenteral or oral calcium supplements, the anatomical pathology and the presence of other complications (recurrent paralysis, seroma, haematoma, etc.).</p><p id="par0080" class="elsevierStylePara elsevierViewall">We extracted a sample of preoperative blood after induction of anaesthesia and before starting surgery, to determine baseline levels of total, ionic and corrected ionic calcium and intact PTH. After closing the surgical incision and before awakening the patient, an immediate postoperative sample of total, ionic and corrected ionic calcium and intact PTH was extracted (immediate postoperative measurements). Late postoperative levels of intact PTH were determined hours after surgery (at 8<span class="elsevierStyleHsp" style=""></span>pm if the patient was operated in the morning, or at 8<span class="elsevierStyleHsp" style=""></span>am if the patient was operated on the previous evening). Late postoperative levels of total, ionic and corrected ionic calcium were extracted 8, 12, 24, and 48<span class="elsevierStyleHsp" style=""></span>h after surgery.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Intact PTH levels were analysed through immunoassay in an Immulite<span class="elsevierStyleSup">®</span> 2500 device (Siemens Healthcare Diagnostics) at the Department of Endocrine Biochemistry.</p><p id="par0090" class="elsevierStylePara elsevierViewall">We calculated the percentages of immediate and late postoperative decrease of PTH using the following formula:<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0245" class="elsevierStylePara elsevierViewall">Patients who presented hypocalcaemia were treated according to the protocol shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. To determine the onset of treatment with calcium or to plan hospital discharge, PTH levels were not taken into account.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using SPSS version 12.0 for Windows (Chicago, IL, USA), in collaboration with the biostatistics unit. The level of significance was established at <span class="elsevierStyleItalic">P</span><.05. We estimated the areas under the corresponding receiver operating characteristic (ROC) curves to calculate and compare the predictive power of the absolute values and percentages of immediate and late postoperative decrease of PTH. The two cut-off points needed to stratify patients were established by analysing the ROC curves, estimating the sensitivity and specificity of each of them.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Population Studied</span><p id="par0100" class="elsevierStylePara elsevierViewall">The population consisted of 108 patients who underwent total thyroidectomy in 1 or 2 stages between February 2009 and March 2010. The ages of the patients are shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>. A total of 75.9% were female and 24.1% were male. Their preoperative diagnoses are summarised in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">A total of 91.7% of the patients underwent total thyroidectomy in one stage and 8.3% in two stages. Unilateral or bilateral recurrent dissections were performed in the same operation in 2.8% and 1.9% of cases, respectively; and unilateral or bilateral functional neck dissections were carried out in 3.7% and 0.9%, respectively.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Four parathyroid glands were identified in 46.7% of cases, three in 31.8%, two in 19.6% and one in 1.9%. One parathyroid gland was autotransplanted in 7.4% of patients.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The results of anatomical–pathological examination of the resected thyroid glands are presented in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Mean hospital stay was 4.9 days (median 4 days, range 3–44 days). A total of 87 patients (80.6%) did not require calcium treatment, 12 (11.1%) received oral calcium supplements, and 8 (7.4%) received intravenous treatment. One patient developed hypocalcaemia of difficult treatment, requiring an endocrinology consultation.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Up to 17 patients (15.9%) presented recurrent paralysis. In all these cases, the paralysis was temporary and vocal cord mobility was recovered between 1 and 4 months after surgery.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Two patients (1.9%) presented postoperative haemorrhage that required surgical review and 7 (6.5%) patients presented serohaematoma.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Predictive Analysis of Hypocalcaemia</span><p id="par0135" class="elsevierStylePara elsevierViewall">Out of the 108 total patients, 26 were not involved in the predictive analysis of hypocalcaemia because they met one of the exclusion criteria outlined above. Therefore, each analysis group (immediate PTH and late PTH) included 82 patients.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Considering only the patients included, 83.3% did not require treatment for hypocalcaemia and 16.7% received calcium. This treatment was oral in 9.5% of cases and intravenous in 7.2%.</p><p id="par0145" class="elsevierStylePara elsevierViewall">The levels of preoperative total calcium and intact PTH, and the immediate and late postoperative levels of total calcium, intact PTH and decreased intact PTH are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">The average time elapsed between surgery and obtaining the late PTH sample was 8.5<span class="elsevierStyleHsp" style=""></span>h, with a range between 4.75 and 22.5<span class="elsevierStyleHsp" style=""></span>h. The Pearson correlation coefficient for the time until determination of late PTH and late postoperative PTH decrease was <span class="elsevierStyleItalic">r</span>: −0.047 (<span class="elsevierStyleItalic">P</span>=.68) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">The area under the ROC curve for the immediate PTH was 0.874; for late PTH, it was 0.932; for immediate postoperative PTH decrease, it was 0.908; and for late PTH decrease, it was 0.961 (all with <span class="elsevierStyleItalic">P</span><.001) (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). Consequently, we chose the percentage of late PTH decrease as a predictor of hypocalcaemia after thyroidectomy.</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">The maximum specificity while maintaining 100% sensitivity was obtained with a late PTH decrease of 79.01% (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), so we chose a value of 80% as the cut-off point. The point with highest sensitivity while maintaining a specificity of 100% for the development of hypocalcaemia corresponded to a decrease of 98.77% (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), so we determined a cut-off point of 98%.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">The contingency table for the stratification of patients using the cut-off points listed above is shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. With these data, we calculated the sensitivity, specificity, predictive values and accuracy of both points. That is to say, 80% to define candidates for early hospital discharge due to their low risk of hypocalcaemia, and 98% to establish which patients would benefit from early treatment with calcium due to for their high risk of developing hypocalcaemia (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). Using this test, 73.2% of patients could have been discharged within 24<span class="elsevierStyleHsp" style=""></span>h after surgery.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0170" class="elsevierStylePara elsevierViewall">There are many controversies and many differences in the design of studies on hypocalcaemia and PTH after thyroidectomy.</p><p id="par0175" class="elsevierStylePara elsevierViewall">Some series have used rapid determination (intraoperative) of PTH, and others have used intact PTH determination.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Lindblom et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> reported that, since transient hypoparathyroidism is a major contributing factor for the development of hypocalcaemia after thyroidectomy, low intraoperative Turbo PTH assay levels could predict which patients are at risk of postoperative hypocalcaemia, and thus help to select candidates for early discharge. For those researchers, the capacity of PTH to predict hypocalcaemia was not significantly different from that of conventional monitoring of calcium levels. Other authors<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,13–18</span></a> also concluded that intraoperative PTH could predict the risk of suffering hypocalcaemia and could, therefore, be used for early discharge of patients, although different cut-off points were established.</p><p id="par0185" class="elsevierStylePara elsevierViewall">Regarding intact PTH, Soon et al.,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Payne et al.,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,20,21</span></a> Lombardi et al.,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Vescan et al.,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> and Scurry et al.,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> concluded that intact PTH determined a number of hours after surgery could predict the development of hypocalcaemia before calcium levels. Again, the cut-off points varied between the different studies, as did the time between the operation and the determination of intact PTH.</p><p id="par0190" class="elsevierStylePara elsevierViewall">In our hospital, the determinations of both intraoperative and intact PTH are available. However, given that we do not intend to discharge patients within 24<span class="elsevierStyleHsp" style=""></span>h after surgery due to the risk of developing other complications of thyroidectomy, we choose the determination of intact PTH for its higher efficiency.</p><p id="par0195" class="elsevierStylePara elsevierViewall">The timing of PTH sample collection varied among the studies cited. In their review, Grodski and Serpell<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> concluded that any time from 10<span class="elsevierStyleHsp" style=""></span>min to several hours after surgery provided equally accurate results in predicting hypocalcaemia (grade C recommendation). Since we obtained a better area under the ROC curve for the late postoperative PTH than for the immediate, we chose the late determination. The time at which the late sample was taken in our study was variable, making it a real parameter, typical of everyday clinical practice. However, we worried that this variability might influence the late PTH decrease values obtained. Consequently, we decided to perform a Pearson correlation to analyse whether the time until the determination had any influence on the results of late PTH decrease. We found no relationship between both parameters.</p><p id="par0200" class="elsevierStylePara elsevierViewall">Some of the aforementioned authors used absolute PTH values, while others preferred the percentage decrease in PTH as a predictor of hypocalcaemia. In their review, Grodski and Serpell<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> referred that both absolute values and PTH decrease could be used with similar accuracy and that, although similar, the levels varied between institutions. For this reason, each centre must validate its own reference values before using the PTH determination selected, and this was the purpose of our study. We chose the percentage of late PTH decrease instead of the absolute late PTH value because capability of late PTH decrease to predict the development of hypocalcaemia was higher, according to our data. In addition, given the differences between the reference values depending on the analyzer used, a percentage difference between preoperative and postoperative values seemed easier to generalise for its use at other centres than an absolute value.</p><p id="par0205" class="elsevierStylePara elsevierViewall">We took an 80% decrease of late PTH as the cut-off point for the selection of candidates for early discharge, as it had the highest specificity with 100% sensitivity: patients with postoperative late PTH decrease less than 80% presented a minimum risk of hypocalcaemia, so they could be discharged within 24<span class="elsevierStyleHsp" style=""></span>h after surgery.</p><p id="par0210" class="elsevierStylePara elsevierViewall">In their review, Grodski and Serpell<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> concluded that the routine use of oral calcium supplements could reduce the incidence and severity of hypocalcaemia after thyroidectomy (grade B recommendation). We only considered the administration of calcium before the onset of hypocalcaemia for those patients at high risk of developing it, given that we wanted to reduce this group of patients as much as possible, since the unnecessary administration of calcium may delay the recovery of transient parathyroid hypofunction, and this recovery is stimulated in the presence of hypocalcaemia. In order to select those patients who were candidates for early treatment with calcium, we determined the cut-off point for late decrease with the highest sensitivity, and a specificity of 100%. This cut-off point corresponded to a percentage of late PTH decrease greater than or equal to 98%.</p><p id="par0215" class="elsevierStylePara elsevierViewall">Using both cut-off points, we stratified our patients into the 3 risk groups outlined above, namely: (1) patients at minimal risk of hypocalcaemia, who could be discharged at 24<span class="elsevierStyleHsp" style=""></span>h; (2) patients with increased risk of hypocalcaemia, who would initiate treatment with calcium supplements before the onset of symptoms; and (3) patients with intermediate risk of hypocalcaemia, who would be admitted for 48<span class="elsevierStyleHsp" style=""></span>h, following the standard procedure for the detection and treatment of hypocalcaemia. We should note that, using these criteria, none of the patients who would have been discharged early would have developed hypocalcaemia. Furthermore, only in one case who would have been treated with calcium before the onset of symptoms would such treatment have been unnecessary, since the patient would have presented hypocalcaemia.</p><p id="par0220" class="elsevierStylePara elsevierViewall">The sensitivity and specificity of the cut-off points for late PTH decrease of 80% and 98% determined in our study suggest that it is possible to stratify patients into the 3 risk groups discussed, and act accordingly. A time validation of the model is currently being conducted in order to test its reliability. In the future, we intend to conduct an external validation which allows us to generalize it for other centres.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0225" class="elsevierStylePara elsevierViewall">The decrease in PTH levels is a good predictor of hypocalcaemia, especially if the PTH determination is carried out some hours after surgery. A postoperative late PTH decrease of 80% or more predicts the development of hypocalcaemia with excellent sensitivity and specificity. A late decrease greater than or equal to 98% could be a reliable criterion for initiating treatment with calcium before the onset of symptoms of hypocalcaemia.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Financing</span><p id="par0230" class="elsevierStylePara elsevierViewall">Grants for Applied Clinical Research Projects of the Foundation for <span class="elsevierStyleGrantSponsor">Biomedical Research, La Paz University Hospital</span>, 2009.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interests</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:2 [ "identificador" => "xres94745" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction and objective" 2 => "Material and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec81898" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres94744" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción y objetivos" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec81899" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Population Studied" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Predictive Analysis of Hypocalcaemia" ] ] ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Financing" ] 10 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of Interests" ] 11 => array:2 [ "identificador" => "xack35135" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-10-28" "fechaAceptado" => "2011-01-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec81898" "palabras" => array:4 [ 0 => "Parathyroid hormone (parathormone)" 1 => "Predictor" 2 => "Hypocalcemia" 3 => "Thyroidectomy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec81899" "palabras" => array:4 [ 0 => "Paratohormona" 1 => "Predictor" 2 => "Hipocalcemia" 3 => "Tiroidectomía" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The risk of developing hypocalcemia is the reason for prolonged hospitalisation after total thyroidectomy. The objective of this study was to validate parathyroid hormone measurement for predicting post-thyroidectomy hypocalcemia.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Eighty-two patients who underwent total or completion thyroidectomy from February 2009 to March 2010 were enrolled in this prospective study to determine the best timing and cutoff point of parathyroid hormone to predict hypocalcemia. Patients with any condition that could interfere with calcium homeostasis were excluded from the survey. Parathyroid hormone and serum calcium levels were determined preoperatively, immediately after surgery and a number of hours later.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Treatment for hypocalcemia was required in 16.7% of patients. A percent of delayed decrease in parathyroid hormone was chosen as the best measurement to predict hypocalcemia. An 80% or higher decrease in delayed parathyroid hormone levels had 100% sensitivity (95% CI: 77.2%–100%) and 87% specificity (95% CI: 77%–93%) for selecting patients for early discharge. Using this test, 73.2% of the patients could have been discharged 24<span class="elsevierStyleHsp" style=""></span>h after surgery. A 98% decrease in delayed parathyroid hormone levels could select candidates for early calcium replacement with 98.6% specificity (95% CI: 92.2%–99.7%).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The decrease in postoperative delayed parathyroid hormone levels is a good predictor of post-thyroidectomy hypocalcemia. A decrease of 80% or more in delayed parathyroid hormone level is a test with excellent sensibility and specificity for selecting candidates for early discharge. The 98% cutoff point has high specificity for selecting patients for early calcium replacement.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El riesgo de hipocalcemia es el motivo para prolongar la hospitalización de los pacientes intervenidos de tiroidectomía. Nos planteamos validar la determinación de paratohormona intacta para predecir el desarrollo de hipocalcemia.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realizó un estudio prospectivo en 82 pacientes intervenidos de tiroidectomía total entre febrero de 2009 y marzo de 2010 para establecer el momento de la determinación y el punto de corte de paratohormona más predictivos de hipocalcemia. Los pacientes con condiciones que pudieran interferir con la homeostasis del calcio fueron excluidos. Se determinaron la paratohormona y los niveles de calcio séricos preoperatoriamente, en el postoperatorio inmediato y en el tardío.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El 16,7% de los pacientes presentaron hipocalcemia. La disminución tardía de paratohormona demostró ser la prueba más precisa para detectar hipocalcemia. El punto de corte para seleccionar candidatos al alta precoz se estableció en una disminución del 80%, con una sensibilidad del 100% (IC95%: 77,2-100%) y una especificidad del 87% (IC95%: 77-93%). Empleando esta prueba, el 73,2% de los pacientes podrían haber recibido el alta a las 24<span class="elsevierStyleHsp" style=""></span>h de la cirugía. Se tomó como punto de corte para establecer candidatos a tratamiento precoz con calcio una disminución de la paratohormona del 98%, la especificidad fue del 98,6% (IC95%: 92,2-99,7%).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La disminución tardía de paratohormona es un buen predictor de hipocalcemia postiroidectomía, que permite estratificar a los pacientes en tres grupos según su riesgo de hipocalcemia usando dos puntos de corte. El punto de corte del 80% presenta una sensibilidad y especificidad excelentes para seleccionar candidatos al alta hospitalaria precoz. El punto de corte del 98% presenta una alta especificidad para seleccionar candidatos a tratamiento precoz con calcio.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Del Río L, et al. Valor predictivo de la paratohormona en la hipocalcemia postiroidectomía. Acta Otorrinolaringol Esp. 2011;62:265-73.</p>" ] ] "multimedia" => array:10 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1472 "Ancho" => 2917 "Tamanyo" => 249420 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Protocol for treatment of hypocalcaemia after thyroidectomy.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1979 "Ancho" => 2486 "Tamanyo" => 126578 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Age histogram of the 108 patients operated on.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1465 "Ancho" => 2812 "Tamanyo" => 205645 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Preoperative and anatomical–pathological diagnoses of the 108 patients undergoing surgery. Ca, carcinoma.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1625 "Ancho" => 2097 "Tamanyo" => 124091 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Pearson's correlation for time until determination of late PTH and postoperative late PTH decline. iPTH, intact parathyroid hormone.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 3062 "Ancho" => 2882 "Tamanyo" => 323215 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ROC curves for absolute values and percentages of postoperative immediate and late PTH decrease. ABC, area below the curve; iPTH, intact parathyroid hormone; GS5% glucose serum at 5%.</p>" ] ] 5 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Dec, decrease; iPTH, intact parathyroid hormone.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Preoperative</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Immediate Postoperative</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Late Postoperative</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Calcium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">iPTH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Calcium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">iPTH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% Dec. iPTH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Calcium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">iPTH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% Dec. iPTH \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−47.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−37.59 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Median \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−60.32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−50.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Typical deviation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.80 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Minimum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−99.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−99.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maximum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">222 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">117 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">157.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">267 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">307.14 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab179572.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Preoperative and Postoperative Levels of Immediate and Late Calcium, Parathyroid Hormone and Parathyroid Hormone Decrease.</p>" ] ] 6 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Dec, decrease; iPTH, intact parathyroid hormone; Spe, specificity; Sen, sensitivity.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% Dec. late iPTH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Sen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">1 Spe \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−100.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−<span class="elsevierStyleBold">98.77</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">0.08</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">0.00</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−98.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−98.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−97.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−97.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−97.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−96.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−96.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n 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\t\t\t\t">0.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−92.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−91.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n 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class="elsevierStyleSimplePara elsevierViewall">Sensitivity and Specificity of Different Cut-Off Points of the Decline in Late Parathyroid Hormone.</p>" ] ] 7 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Hypocalcaemia Treated</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Discharge \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 (73.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 (73.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Observation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (9.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (12.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (22%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Early treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (3.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (4.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 (84.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (15.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab179573.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Contingency Table for Stratification of Patients Using the Cut-Off Points of 80% and 98% for Late Intact Parathyroid Hormone Decrease.</p>" ] ] 8 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">CI, confidence interval; NPV, negative predictive value; PPV, positive predictive value.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">80% Cut-Off (Discharge)</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">98% Cut-Off (Early Treatment)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sensitivity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77%–100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8%–50% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Specificity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77%–93% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92%–100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PPV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39%–77% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30%–95% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NPV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94%–100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78%–93% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Accuracy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80%–94% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78%–92% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab179571.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Sensitivity, Specificity, Predictive Values and Accuracy of the Selected Cut-Off Points for Late Parathyroid Hormone Decrease.</p>" ] ] 9 => array:5 [ "identificador" => "eq0005" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "(PTHpostop−PTHproep)×100PTHproep" "Fichero" => "si1.jpeg" "Tamanyo" => 2748 "Alto" => 40 "Ancho" => 201 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 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Without their efforts and dedication, this work would not exist.</p>" ] ] ] "idiomaDefecto" => "en" "url" => "/21735735/0000006200000004/v1_201304231458/S2173573511000251/v1_201304231458/en/main.assets" "Apartado" => array:4 [ "identificador" => "5871" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735735/0000006200000004/v1_201304231458/S2173573511000251/v1_201304231458/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573511000251?idApp=UINPBA00004N" ]
