Background: Transient hypoparathyroidism is a frequent and challenging complication following total thyroidectomy. The aim of the study was to identify patients at risk of developing thyroidectomy-related hypocalcemia and symptoms by means of the intraoperative quick parathyroid hormone (PTH) assay.
Methods: Eighty-one patients undergoing total thyroidectomy were included in the study. Quick PTH levels were measured at induction of anaesthesia and 10 minutes after total thyroidectomy. A sample of 10 patients who underwent unilateral thyroid lobectomy was considered as a control group. The accuracy of intraoperative PTH decline in predicting postoperative hypoparathyroidism was analysed.
Results: After total thyroidectomy, 27 patients (33.3%) developed postoperative hypocalcemia. Symptoms were reported by 21 patients (25.9%). The mean percentage decline of intraoperative quick PTH was 81% in hypocalcemic compared with 39% in normocalcemic patients (P<0.001), and it was 83% in symptomatic compared with 42% in asymptomatic patients (P<0.001). Mean proportion decline of quick PTH after unilateral lobectomy was 20%, significantly lower than the 53% registered after total thyroidectomy (P=0.005). Analysis of variation of intraoperative quick PTH with the receiver operator characteristics (ROC) curve showed a 75.7% decline as the cut-off value predicting postoperative hypocalcemia with the highest accuracy (91.4%) (sensitivity: 81.5% specificity: 96.3% positive likelihood ratio: 22; negative likelihood ratio: 0.2). Regarding the prediction of postoperative symptoms, a 79.5% decline was the most accurate (92.6%) cut-off point (sensitivity: 76.2% specificity: 98.3% positive likelihood ratio: 46; negative likelihood ratio: 0.2).
Conclusions: Quick PTH monitoring during total thyroidectomy is a useful means for identifying low-risk patients for postoperative hypoparathyroidism and candidates for early, safe discharge. Furthermore, it is an objective method complementary to the surgeon's judgement of the intraoperative function of parathyroid glands, which should be implanted in the event of a 75%-80% decline.
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http://dx.doi.org/10.1007/s00268-005-0606-8 | DOI Listing |
Acad Radiol
January 2025
Department of Ultrasound, Chengdu Second People's Hospital, Chengdu 610000, China (X.L., X.Q.). Electronic address:
Rationale And Objectives: This study aims to develop a radiopathomics model based on preoperative ultrasound and fine-needle aspiration cytology (FNAC) images to enable accurate, non-invasive preoperative risk stratification for patients with papillary thyroid carcinoma (PTC). The model seeks to enhance clinical decision-making by optimizing preoperative treatment strategies.
Methods: A retrospective analysis was conducted on data from PTC patients who underwent thyroidectomy between October 2022 and May 2024 across six centers.
Endocrinol Diabetes Metab Case Rep
January 2025
Summary: Oral levothyroxine (LT4) is prescribed worldwide for hypothyroidism. Bariatric surgery for patients with obesity has shown a substantial, long-term weight loss and considerable improvement of obesity-related diseases. LT4 malabsorption represents a significant cause of refractory hypothyroidism, well known after malabsorptive bariatric surgery such as Roux-en-Y gastric bypass.
View Article and Find Full Text PDFOtolaryngol Head Neck Surg
January 2025
Department of Otolaryngology-Head and Neck Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA.
Objective: The objective of this study is to examine the risk of hypocalcemia after thyroidectomy in patients taking histamine-2 receptor antagonists.
Study Design: Retrospective cohort study.
Setting: Multicenter, single database.
BMC Endocr Disord
January 2025
The Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, China.
Background: The importance of parathyroid gland preservation in thyroid surgery has been well recognized; however, the rapid identification of the parathyroid gland, particularly the inferior parathyroid gland (IPG), remains challenging. This study aimed to evaluate the effectiveness of retrograde inferior parathyroid protection technique (RIPPT) based on thymus preservation.
Methods: A total of 236 patients were enrolled in this study between August 2019 and December 2020.
Acta Med Indones
October 2024
Akdeniz University, Faculty of Medicine, Department of General Surgery, 07070, Antalya, Turkey.
A 36-year-old woman with a history of neck swelling was diagnosed with papillary thyroid carcinoma, a common but typically slow-growing thyroid cancer with a good prognosis. Despite frequent lymph node metastasis, mortality rates are low. This cancer can rarely spread to unusual areas like the axillary region.
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