Parathyroid hormone‐driven algorithms after thyroid surgery: Not one‐size‐fits‐all. Issue 3 (26th December 2022)

• Record Type: Journal Article
• Authors: Samargandy, Shireen; Wadie, John; Msallak, Haytham; Chiodo, Albino; El Masri, William; Hubbard, Bradley; Enepekides, Danny; Higgins, Kevin; Assal, Angela; Fine, Rebecca; Fung, Raymond; Nicholas, Everton; Beadle, Valrie; Eskander, Antoine
• Is Part Of: Head & neck. Volume 45:Issue 3(2023)
• Page Start: 595
• Page End: 603
• Publication Date: 2022-12-26
• Subjects: hypocalcemia -- hypoparathyroidism -- parathyroid hormone -- thyroid -- thyroidectomy; Head -- Diseases -- Periodicals; Neck -- Diseases -- Periodicals; Head -- Periodicals; Neck -- Periodicals; Face -- Periodicals; 617.51059
• DOI: 10.1002/hed.27272
• Languages: English
• ISSNs: 1043-3074

Abstract

Abstract: Background: Underreported variation in parathyroid hormone (PTH) assays exists. Using quality improvement methods, we aimed to develop an institution‐specific PTH‐based protocol to predict hypocalcemia after thyroidectomy. Methods: We retrospectively reviewed patients who underwent total/completion thyroidectomy. A receiver operating curve (ROC) determined postoperative PTH cut‐offs predictive of hypocalcemia. The stakeholders developed PTH‐driven calcium management guidelines. Post‐implementation outcomes were prospectively measured. Results: Pre‐implementation, 95 patients were assessed. PTH ≤1.5 pmol/L (14.1 pg/ml) predicted hypocalcemia (96%sensitivity), and ≥2.8 pmol/L (26.4 pg/ml) predicted normocalcemia (99%specificity) (area under curve = 0.97, SEM = 0.018). PTH on the day of and morning after surgery were identically predictive. Post‐implementation, 64 patients were assessed. Hypocalcemia occurred with PTH >2.8 pmol/L in 2 cases (3.1%). Calcium over‐prescribing decreased from 13.7% to 3.1% ( p = 0.06). Length of stay (LOS) > 2 nights decreased from 13% to 3.1% ( p = 0.05). Conclusion: A PTH‐driven calcium management protocol post‐thyroidectomy effectively reduces unnecessary calcium replacement and LOS. Given the variability in PTH assays, each institution may need to use individual cut‐offs.