Early detection of hypocalcemia after total/completion thyroidectomy: routinely usable algorithm based on serum calcium level.

Abstract

BACKGROUND:

The purpose of this prospective bicentric study was to investigate the course of serum calcium (Ca) and phosphorus (Phph) after total/completion thyroidectomy to establish a reliable and cost-effective strategic algorithm to detect patients at risk for postoperative hypocalcemia.

METHODS:

This observational study included 136 patients. Serum Ca and Phph levels were preoperatively and postoperatively recorded 6, 12, 20, and 48 h (H) after skin closure. Criteria for hypocalcemia were postoperative Ca levels ≤1.9 mmol/L at any time point and/or patients experiencing symptoms of hypocalcemia. Postoperative Ca supplementation was never given before H20 assay. Ca levels and their differences between time points were compared.

RESULTS:

Twenty-four percent of patients experienced hypocalcemia. At H12 and H20, the rates of patients with Ca levels ≤1.9 mmol/L were similar and larger than at H6 (p < 0.001). The H20-preoperative difference had the best area under the ROC curves (value = 0.87), and a difference ≤-0.3 was significantly more frequent in case of hypocalcemia (p = 0.001). The H20 assay and the difference H20-preop were consequently selected to design a new algorithm for hypocalcemia detection. Adding H48 assay in some specific cases (12.5 % of all included patients) enabled 100 % detection. Phosphorus assays were not informative in detecting hypocalcemia.

CONCLUSIONS:

This new algorithm enables, with 100 % sensitivity and 88.4 % specificity, early detection of severe hypocalcemia after total/completion thyroidectomy. It may become a useful and cost-effective tool for safe and early patient discharge, especially if PTH assays cannot be routinely used because of their availability or cost.

• Authors: Diane S Lazard, Gaëlle Godiris-Petit, Isabelle Wagner, Emile Sarfati, Frédéric Chabolle
• Journal: World journal of surgery (World J Surg) Vol. 36 Issue 11 Pg. 2590-7 (Nov 2012) ISSN: 1432-2323 [Electronic] United States
• PMID: 22855216 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Calcium

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Algorithms
• Calcium (blood)
• Early Diagnosis
• Female
• Humans
• Hypocalcemia (blood, diagnosis, etiology)
• Male
• Middle Aged
• Prospective Studies
• Thyroidectomy (adverse effects, methods)
• Young Adult