Early parathyroid hormone (PTH) level as a predictor of post-surgical hypoparathyroidism.

ABSTRACT Introduction: Post-operative hypocalcemia and postoperative persistent hypoparathyroidism remain the most common complications after thyroidectomy. Many approaches have been developed to prevent them, but actually, a common protocol is not yet individuated. Materials and methods: We retrospectively analyzed the results of a prospectively collected database. We dosed PTH preoperatively and 4h after surgery (PTH_4); calcium was evaluated preoperatively, on the first (I_POD) and on the second postoperative day (II_POD). Hypocalcemia was defined when calcium <8mg/dl. PTH_4 and I_POD calcium serum levels are identified to predict postoperative hypocalcemia. Results: Three hundred and forty-eight patients were enrolled, 37 patients resulted as hypo calcemic on I_POD and 41 on the II_POD. PTH_4 is related to I_POD (p < 0.001, r = 0.45) and II_POD (p < 0.001, r = 0.44) calcemia. PTH_4-cut-off predicting I_POD hypocalcemia was 10.50pg/ml (sensitivity: 78.7%, specificity: 72.7%). A PTH_4 value of 11.5pg/ml is able to pre dict hypocalcemia during II_POD (sensitivity: 76.5%, specificity: 69.2%). We set up a combined test to predict II_POD hypocalcemia, using PTH_4 and I_POD calcium (sensitivity: 77.8%, spec ificity: 89.9%). Conclusion: This research shows the association between PTH_4 and postoperative hypocal cemia. The PTH_4 cut-off to predict I_POD-hypocalcemia was 10.5pg/ml. We analyzed the calcemia trend during the postoperative period and we realized a combined test using PTH_4 and I_POD-calcemia. This test improves the accuracy of the previous test. Further studies, in particular multicentric, with a larger sample are necessary to validate the combined model.