metricas
covid
Buscar en
Acta Otorrinolaringológica Española
Toda la web
Inicio Acta Otorrinolaringológica Española Parathyroid Hormone as a Predictor of Post-Thyroidectomy Hypocalcemia
Journal Information
Vol. 62. Issue 4.
Pages 265-273 (July - August 2011)
Share
Share
Download PDF
More article options
Visits
3722
Vol. 62. Issue 4.
Pages 265-273 (July - August 2011)
Original article
Parathyroid Hormone as a Predictor of Post-Thyroidectomy Hypocalcemia
Valor predictivo de la paratohormona en la hipocalcemia postiroidectomía
Visits
3722
Laura Del Ríoa,
Corresponding author
lauradelrioarroyo@gmail.com

Corresponding author.
, Alejandro Castroa, Ricardo Bernáldeza, Antonio Del Palacioa, Carolina V. Giráldezb, Beatriz Lecumberric, Cristina Álvarez-Escolác, Alberto Fernández-Martínezc
a Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, Spain
b Departamento de Bioestadística, Hospital Universitario La Paz, Madrid, Spain
c Servicio de Endocrinología, Hospital Universitario La Paz, Madrid, Spain
This item has received
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (5)
Show moreShow less
Tables (4)
Table 1. Preoperative and Postoperative Levels of Immediate and Late Calcium, Parathyroid Hormone and Parathyroid Hormone Decrease.
Table 2. Sensitivity and Specificity of Different Cut-Off Points of the Decline in Late Parathyroid Hormone.
Table 3. Contingency Table for Stratification of Patients Using the Cut-Off Points of 80% and 98% for Late Intact Parathyroid Hormone Decrease.
Table 4. Sensitivity, Specificity, Predictive Values and Accuracy of the Selected Cut-Off Points for Late Parathyroid Hormone Decrease.
Show moreShow less
Abstract
Introduction and objective

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.

Material and methods

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.

Results

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 24h 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%).

Conclusions

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.

Keywords:
Parathyroid hormone (parathormone)
Predictor
Hypocalcemia
Thyroidectomy
Resumen
Introducción y objetivos

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.

Material y métodos

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.

Resultados

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 24h 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%).

Conclusiones

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.

Palabras clave:
Paratohormona
Predictor
Hipocalcemia
Tiroidectomía

Article

These are the options to access the full texts of the publication Acta Otorrinolaringológica Española
Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe
Subscribe to

Acta Otorrinolaringológica Española

Purchase
Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
E-mail
Article options
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos