TITLE:
Post Thyroidectomy Assessment of Intact Parathyroid Hormone for Early Prediction of Hypocalcaemia
AUTHORS:
Md. Masum Billah, Ripon Kumar Sarkar, Md. Yousuf Ali, Saad Zaman, Md. Nazmul Hasan, Md. Shehab Uddin, Md. Mosleh Uddin, Kazi Shameemus Salam, Farzana Binte Abedin Leera
KEYWORDS:
Total Thyroidectomy, Hypocalcaemia, Serum Intact Parathyroid Hormone, Early Predictor of Hypocalcaemia
JOURNAL NAME:
International Journal of Otolaryngology and Head & Neck Surgery,
Vol.13 No.2,
February
26,
2024
ABSTRACT: Background: As the half-life of intact parathyroid hormone (iPTH) is very low, it reflects
parathyroid insufficiency within minutes to hours after total thyroidectomy.
Therefore, iPTH level assessment in the postoperative period can be used to
predict the development of hypocalcaemia. The optimal time point to measure
serum iPTH is important for the accurate prediction of hypocalcaemia. Aim: This paper aims to evaluate the ability of iPTH as an early predictive marker of
hypocalcaemia and determine which time iPTH is more able to predict postoperative hypocalcaemia. Method: This prospective
observational study was conducted in the Department of
Otolaryngology-Head & Neck Surgery, BSMMU, Dhaka, from July 2020 to
December 2021, with 67 patients who underwent total thyroidectomy. iPTH levels
were measured on the day before the operation and at 1 hour, 4 hours, and 24
hours after the operation. S.calcium levels
were measured on the day before the operation and 1st postoperative day. All the data were compiled and sorted properly and were
analyzed statistically. Results: Postoperative hypocalcaemia developed
in 18 cases, with an incidence of 26.9%. Pearson correlation showed a
significant correlation between postoperative iPTH at 1 hr, 4 h, and 24 hr with
1st postoperative calcium value. The Receiver operating characteristic (ROC) curve was processed for the postoperative iPTH
at 1 hr, 4 h, and 24 hr. The sensitivity, specificity, cut-off value, and mean
AUC found 93.9%, 94.4%, ≤14.0, 0.988; 95.9%, 94.4%, ≤09.5, 0.993 and
91.8%, 94.4%, ≤11.0, 0.993 respectively. Conclusion: iPTH can be used as
an early predictor of post-thy-roidectomy hypocalcaemia. 4 hr iPTH showed more
sensitivity and specificity for a cut-off value near the laboratory reference
range.