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Inicio Acta Otorrinolaringológica Española Early hospital discharge through prediction of post-thyroidectomy hypoparathyroi...
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Vol. 75. Issue 4.
Pages 238-243 (July - August 2024)
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Vol. 75. Issue 4.
Pages 238-243 (July - August 2024)
Original article
Early hospital discharge through prediction of post-thyroidectomy hypoparathyroidism
Alta hospitalaria precoz mediante la predicción temprana del hipoparatiroidismo postiroidectomía
Antonio Galindo Fernándeza,b,
Corresponding author
, Ana Giribet Fernández-Pachecoa, Nathalie Fages Cárcelesa, Laura Espinosa Fernándeza, Alba Molina Morenoa, Francisco José García-Purriños Garcíaa,b
a Servicio de Otorrinolaringología y Cirugía de Cabeza de Cuello, Hospital General Universitario Los Arcos del Mar de Menor, Pozo Aledo, Murcia, Spain
b Health Sciences PhD Program, Universidad Católica de Murcia UCAM, Campus de los Jerónimos n°135, Guadalupe, 30107, Murcia, Spain
Article information
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Table 1. Risk factors for temporary and permanent hypoparathyroidism.6
Abstract
Introduction

Hypoparathyroidism is the most common postsurgical complication of total thyroidectomy. Furthermore, it is the main cause of prolonged hospitalisation after this procedure.

Objective

To predict the probability of post-thyroidectomy hypocalcaemia according to the levels of intact parathyroid hormone (iPTH), as well as to determine the needs for treatment with exogenous calcium according to the levels of serum calcium (Ca).

Materials and methods

Retrospective study was carried out on patients who underwent total thyroidectomy between January 2017 and January 2020 at Los Arcos del Mar Menor University Hospital (HULAMM). iPTH and Ca levels ​​were measured at 4, 24 and 48 h after the surgery. Follow-up was 6 months.

Results

Ninety-four patients were operated on. Temporary and permanent postoperative hypoparathyroidism percentages were, respectively, 51.06% and 6.38%. iPTH level 24 h after the procedure was the most reliable predictor of post-thyroidectomy temporary hypoparathyroidism (Area Under the ROC Curve (AUC) = 0.933, p < .001). iPTH levels ​​≥29 pg/mL predicted normal parathyroid metabolism.

Conclusions

The combined values of iPTH and Ca levels 24 h after thyroidectomy seems to be a reliable, safe and efficient method to control the post-thyroidectomy hypoparathyroidism. Our protocol could reduce the hospital stay of patients at low risk of hypocalcaemia, allowing them to be discharged from the hospital on the first postoperative morning and identifying patients at high risk of hypocalcaemia early.

Keywords:
Hypoparathyroidism
Total thyroidectomy
Parathyroid hormone
Calcium
Abbreviations:
(AUC)
(Ca)
(HULAMM) H
(ENT-HNS) O
(iPTH)
(ROC) R
(PPV) P
(PNV)
Resumen
Introducción

El hipoparatiroidismo es la complicación postquirúrgica más frecuente de la tiroidectomía total. Además, constituye la principal causa de ingreso hospitalario prolongado tras esta intervención.

Objetivo

Predecir precozmente la probabilidad de hipocalcemia postiroidectomía según los niveles de hormona paratiroidea intacta (PTHi), así como determinar las necesidades de tratamiento con calcio exógeno según los niveles de calcio sérico (Ca).

Materiales y métodos

Se realizó un estudio retrospectivo de pacientes intervenidos de tiroidectomía total entre enero de 2017 y enero de 2020 en el Hospital Universitario Los Arcos del Mar Menor (HULAMM). Se seriaron analíticamente los valores de PTHi y Ca a las 4, 24 y 48 horas tras la intervención. El seguimiento fue de 6 meses.

Resultados

Fueron intervenidos 94 pacientes. Las tasas de hipoparatiroidismo posoperatorio temporal y permanente fueron del 51,06% y 6,38%, respectivamente. La determinación de PTHi a las 24 horas tras la intervención fue el predictor más fiable de hipoparatiroidismo transitorio postiroidectomía (Área Bajo la Curva ROC (AUC) = 0,933, p < 0,001). Valores de PTHi ≥ 29 pg/mL predijeron un metabolismo paratiroideo normal.

Conclusiones

La medición combinada de los niveles de PTHi y Ca a las 24 horas tras la tiroidectomía parece ser un método fiable, seguro y eficiente para el control del hipoparatiroidismo postiroidectomía. Nuestro protocolo podríaidentificar a los pacientes con alto riesgo de hipocalcemia precozmente, así como reducir la estancia hospitalaria de los pacientes con bajo riesgo de hipocalcemia, permitiendo su alta hospitalaria en la primera mañana del posoperatorio y evitando tratamientos prescindibles.

Palabras clave:
Hipoparatiroidismo
Tiroidectomía total
Hormona paratiroidea
Calcio

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