Reliable Early Prediction for Different Types of Post-Thyroidectomy Hypocalcemia

김준호,정만기,손영익 대한이비인후과학회 2011 Clinical and Experimental Otorhinolaryngology Vol.4 No.2

Objectives. High incidence of hypocalcemia after thyroidectomy is a major determinant in delay of discharge. Even though many studies have focused on the search for reliable early predictors of postoperative hypocalcemia, definitions of hypocalcemia are diverse; therefore, interpretation and application of previously reported findings may not be easy. We aimed to elucidate diverse patterns of post-thyroidectomy hypocalcemia and to provide reliable early predictors for these different types of hypocalcemia. Methods. Retrospective chart review was performed and eligible 112 patients of thyroidectomy were categorized into four groups according to symptomatic and/or biochemical hypocalcemic criteria. A mismatch of occurrence and the timing of symptomatic or biochemical abnormalities were evaluated. Predictive values of commonly used biomarkers were compared in each group; levels of serum total calcium and ionized calcium, and intact parathyroid hormone (PTH). Results. Among 62 hypocalcemic patients, 45 patients (72.5%) experienced both symptomatic and biochemical abnormalities during hospitalization. A mismatch on the timing of initial detection of symptomatic and biochemical hypocalcemia was observed in 21 patients (46.6%). Intact PTH level measured at 1 hour was a useful indicator in prediction of symptomatic hypocalcemia with 79.7-87.4% of diagnostic accuracy. Serum ionized calcium measured next morning after surgery was a reliable predictor of biochemical hypocalcemia with 77.9-94.8% of diagnostic accuracy. Conclusion. For the safety of patients, the possibility of both symptomatic and biochemical hypocalcemia should be considered together before deciding early discharge. Using intact PTH for symptomatic hypocalcemia and day-1 ionized serum calcium level for biochemical hypocalcemia will be helpful for the reliable prediction of heterogeneous nature of postoperative hypocalcemia.

갑상선 유두암 환자의 전절제술 후 부갑상선 기능 저하증의 위험 인자

성지영(Ji Young Seong),이초록(Cho Rok Lee),김민지(Min Jhi Kim),김태형(Tae Hyung Kim),이슬기(Seul Gi Lee),최정범(Jung Bum Choi),반은정(Eun Jeong Ban),강상욱(Sang Wook Kang),이잔디(Jan Dee Lee),정종주(Jong Ju Jeong),남기현(Kee Hyun Nam 대한갑상선-내분비외과학회 2016 The Koreran journal of Endocrine Surgery Vol.16 No.3

Purpose: Postoperative hypocalcemia is a common complication of thyroidectomy. This study evaluated the incidence and predisposing risk factors for postoperative permanent hypocalcemia after total thyroidectomy. Methods: There were 1,247 consecutive patients undergoing total thyroidectomy and complete treatment and observation for differentiated thyroid cancer between January 2012 to December 2012 who were enrolled in this study. Patients were divided into two groups, those remaining normalcalcemic (Group I-824 pts) and those who had hypocalcemia requiring treatment (Groups II-423 pts). Group II was subdivided into a transient hypocalcemic group (Group IIA-409 pts) and a permanent hypocalcemic group (Group IIB-14 pts). Results: Female gender, thyroiditis, preserved parathyroid number, lateral lymph node metastasis, RAI treatment, preoperative parathyroid hormone and preoperative vitamin D were significantly associated with the development of postoperative hypocalcemia by multivariate analysis. Comparing patients with transient versus permanent hypocalcemia, tumor size and multiplicity were significantly related to the development of permanent hypocalcemia by multivariate analysis. RAI treatment and parathyroid hormone level on the postoperative third day were significantly related to recovery from transient hypocalcemia to normo-calcemia. Conclusion: Risk factors of postoperative hypocalcemia were associated with preoperative patient factors and advanced thyroid cancer. Advanced thyroid cancer was a risk factor for permanent hypocalcemia. To prevent postoperative hypocalcemia, we should focus on patient condition and need to preserve parathyroid gland more carefully in thyroid surgery.

Percentage Decline of Parathyroid Hormone Level is a Predictor for Post-thyroidectomy Symptomatic Hypocalcemia

Da mi Jung,Jong kyu Kim,Hyung ju Kwon,Woo sung Lim,Byung In Moon 대한갑상선-내분비외과학회 2017 The Koreran journal of Endocrine Surgery Vol.17 No.4

Purpose: Postoperative hypocalcemia is one of the most common complications after thyroid surgery. However, the predictive efficacy of parathyroid hormone (PTH) level was still controversial. We investigated the cut-off value of perioperative PTH level for postoperative hypocalcemia after total thyroidectomy. Methods: Four hundred eighty-two patients performed total thyroidectomy from January 2015 to December 2016 were enrolled. Demographics, operative variables and the development of symptomatic hypocalcemia were collected and evaluated. Results: Transient symptomatic hypocalcemia occurred in 83 (17.2%) patients and 5 (1.0%) patients have progressed to the permanent hypocalcemia. Patients with transient symptomatic hypocalcemia showed significantly lower postoperative day 1 PTH level than those without hypocalcemia (7.7±6.5 vs. 13.1±10.4 pg/mL; P<0.001), while correlation between postoperative PTH level and development of symptomatic hypocalcemia was not found in a multivariate analysis (P=0.122). Percentage decline of the preoperative PTH only showed significant association with transient hypocalcemia and the recommended cut-off value was 75.0%. When percentage decline of 75.0% was used, the incidence of transient hypoparathyroidism was 3.4 times (95% confidence interval, 2.1-5.6) higher in high percentage decline group (P<0.001). In regard to the permanent hypoparathyroidism, there were no significant differences in all factors. Conclusion: Percentage decline of PTH can be used as a predictive factor for postoperative hypocalcemia. Cautions against preventing injury of the parathyroid glands with careful surgical technique should be recommended.

Percentage Decline of Parathyroid Hormone Level is a Predictor for Post-thyroidectomy Symptomatic Hypocalcemia

정다미,김종규,권형주,임우성,문병인 대한갑상선-내분비외과학회 2017 The Koreran journal of Endocrine Surgery Vol.17 No.4

Purpose: Postoperative hypocalcemia is one of the most common complications after thyroid surgery. However, the predictive efficacy of parathyroid hormone (PTH) level was still controversial. We investigated the cut-off value of perioperative PTH level for postoperative hypocalcemia after total thyroidectomy. Methods: Four hundred eighty-two patients performed total thyroidectomy from January 2015 to December 2016 were enrolled. Demographics, operative variables and the development of symptomatic hypocalcemia were collected and evaluated. Results: Transient symptomatic hypocalcemia occurred in 83 (17.2%) patients and 5 (1.0%) patients have progressed to the permanent hypocalcemia. Patients with transient symptomatic hypocalcemia showed significantly lower postoperative day 1 PTH level than those without hypocalcemia (7.7±6.5 vs. 13.1±10.4 pg/mL; P<0.001), while correlation between postoperative PTH level and development of symptomatic hypocalcemia was not found in a multivariate analysis (P=0.122). Percentage decline of the preoperative PTH only showed significant association with transient hypocalcemia and the recommended cut-off value was 75.0%. When percentage decline of 75.0% was used, the incidence of transient hypoparathyroidism was 3.4 times (95% confidence interval, 2.1–5.6) higher in high percentage decline group (P<0.001). In regard to the permanent hypoparathyroidism, there were no significant differences in all factors. Conclusion: Percentage decline of PTH can be used as a predictive factor for postoperative hypocalcemia. Cautions against preventing injury of the parathyroid glands with careful surgical technique should be recommended.

Clinical and laboratory characteristics of neonatal hypocalcemia

Won Im Cho,Hyeoh Won Yu,Hye Rim Chung,신충호,양세원,최창원,김병일 대한소아내분비학회 2015 Annals of Pediatirc Endocrinology & Metabolism Vol.20 No.2

Purpose: To describe the clinical characteristics of full-term neonates with hypocalcemia and to suggest factors associated with neonatal hypocalcemia Methods: The medical records of full-term neonates with hypocalcemia were reviewed. Hypocalcemia was defined as an ionized calcium (iCa) concentration of <4 mg/dL. Parathyroid hormone (PTH) insufficiency was defined as a serum PTH level of <60 pg/mL or a serum phosphorus level higher than the serum calcium level in the presence of hypocalcemia. Results: Fifty-three neonates were enrolled. The median age at diagnosis of hypocalcemia was 3 days. In all the neonates, formula feeding predominance was observed. Thirty-eight neonates (69.8%) were compatible with PTH insufficiency. The number of formula-fed neonates was significantly higher than that of breastfed patients among neonates with PTH insufficiency (P=0.017). Intact PTH was negatively correlated with serum phosphorus levels. Twelve out of 14 neonates (85.7%) had 25-hydroxy vitamin D (25OHD) levels <20 ng/mL and 9 neonates (64.3%) had 25OHD levels <10 ng/mL. Twenty-one neonates had hypocalcemic tetany. The serum calcium and iCa concentrations of neonates with tetany were 4.2–8.3 mg/dL and 1.85–3.88 mg/dL, respectively. Three neonates showed symptomatic hypocalcemia with calcium levels over 7.5 mg/dL. Among the 16 neonates who underwent electroencephalography (EEG), 12 had abnormalities, which normalized after 1–2 months. Conclusion: Formula milk feeding, PTH insufficiency and low serum vitamin D concentration are associated with the development of neonatal hypocalcemia. Symptoms such as tetany and QT interval prolongation can develop in relatively mild hypocalcemia. Moreover, transient neonatal hypocalcemia can cause transient EEG abnormalities.

Causes and Clinical Features of Transient Hypocalcemia in Newborn: A Single Center Study

Byung Jin Song,Hae Sook Kim,Won Duck Kim 대한신생아학회 2016 Neonatal medicine Vol.23 No.3

Purpose: To review clinical symptoms, laboratory findings, and treatment of transient neonatal hypocalcemia. Method: Medical records of full-term (gestational age ≥37 weeks) neonates diagnosed with hypocalcemia, aged <31 days, were investigated retrospectively. Using a cut-off of 3 days after birth, cases of neonatal hypocalcemia were classified as early or late. Hypocalcemia was defined as ionized calcium level <4 mg/dL or serum calcium level <7.5 mg/dL. Hyperphosphatemia was defined as serum phosphate level >8 mg/dL. Relative hypoparathyroidism was defined as hypocalcemia and hyperphosphatemia with parathyroid hormone level within the normal range (10–65 pg/mL). Results: Of 68 included neonates, 62 were diagnosed with hypoparathyroidism with hypocalcemia and hyperphosphatemia, and 26 had seizures. Mean serum calcium level of the seizure group was 5.99 mg/dL, which was significantly lower than that of the non-seizure group (6.46 mg/dL, P=0.012). The recovery duration for calcium and phosphate levels was long, at 5.8 and 10.7 days, respectively. The calcium level recovery duration was significantly different between the seizure and non-seizure groups (P=0.034), but the phosphate level recovery period was not significantly different (P=0.194). Of 17 patients with diarrhea, 10 had confirmed rotavirus infection. Most patients with hypocalcemia responded well to oral calcium lactate and intravenous calcium gluconate, and the treatments could be discontinued after a certain period. Conclusion: Transient neonatal hypocalcemia is associated with hypoparathyroidism. The major symptom in late neonatal hypocalcemia was the occurrence of seizures. Serum calcium level was lower and the recovery period was longer in the seizure group, but most cases exhibited favorable progress.

갑상선 전절제술 및 근전절제술후 조기킬슘측정을 이용한 저칼슘혈증의 예측

박용호,김태훈,김병국,박찬일 대한이비인후과학회 2001 대한이비인후과학회지 두경부외과학 Vol.44 No.11

Neonatal Late-onset Hypocalcemia: Is There Any Relationship with Maternal Hypovitaminosis D?

Do, Hyun Jeong,Park, Ji Sook,Seo, Ji-Hyun,Lee, Eun Shin,Park, Chan-Hoo,Woo, Hyang-Ok,Youn, Hee-Shang The Korean Society of Pediatric Gastroenterology 2014 Pediatric gastroenterology, hepatology & nutrition Vol.17 No.1

Purpose: Neonatal late-onset hypocalcemia is defined as hypocalcemia developed after postnatal 3 days and associated with hypoparathyroidism, high phosphate diets and vitamin D deficiency. We experienced the increment of neonatal late onset hypocalcemia over 1 year. We tried to evaluate the relationship between late onset hypocalcemia and maternal hypovitaminosis D. Methods: The medical records in the neonates with late-onset hypocalcemia during January 2007 to July 2008 were retrospectively reviewed. Among those patients, 17 paired sera of mothers and neonates had collected. The levels of 25-OH vitamin D (25OHD) and intact parathyroid hormone (iPTH) were measured and were compared with neonate and the mother. Results: The mean gestational age was $38^{+1}$ weeks, and the mean body weight was 2,980 g. The onset time of hypocalcemia was 5.9 days of age. Most of them (88.2%) were feeding with formula and no one was only breast milk feeding. Of the 17 patients, 13 were born in spring or in winter. The median levels of calcium, phosphorus, alkaline phosphatase, iPTH and 25OHD were 7.0 mg/dL, 8.6 mg/dL, 191.0 U/L, 57.2 pg/mL and 24.0 ng/mL in neonates. The levels of 25OHD of 6 neonates were <20 ng/mL. A total of 16 mothers were considered vitamin D-deficient (<20 ng/mL), and vitamin D insufficient (20<25OHD<30 ng/mL). Conclusion: Neonatal late-onset hypocalcemia in our study seems to be influenced by maternal vitamin D deficiency and insufficiency. Sun tanning and vitamin D supplements from winter to spring would be helpful to prevent maternal vitamin D deficiency, one of the causes of neonatal late-onset hypocalcemia.

Impact of preserving the parathyroid glands on hypocalcemia after total thyroidectomy with neckdissection

Yon Seon Kim 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.83 No.2

Purpose: The aims of this study were to determine the incidence and evaluate the risk factors for hypocalcemia after total thyroidectomy and to investigate how many parathyroid glands should be preserved to prevent postoperative hypocalcemia. Methods: From March 2007 to February 2011, a retrospective review of 866 patients who underwent total thyroidectomy and node dissection for thyroid cancer was performed. The incidence and predisposing factors for hypocalcemia were analyzed. Among them, a total of 191 cases had four of their parathyroid glands identified intraoperatively. These patients were then divided into one preserved parathyroid gland group (group I, n = 22) and two or more preserved parathyroid glands group (group II, n = 169). The incidence of hypocalcemia with regards to the number of preserved parathyroid glands was determined and the results between the two groups were compared. The total calcium, ionized calcium and parathyroid hormone levels were compared between the two groups. Results: The overall incidence of transient and permanent hypocalcemia was 9.2% and 0.5%, respectively. The decreased number of preserved parathyroid gland and increased number of removed central lymph node were the significant risk factors for developing postoperative hypocalcemia. In 191 cases identified with four parathyroid glands, the incidence of hypocalcemia was related to the number of preserved glands (group I, 22.7%; group II, 3.0%; P < 0.001). Conclusion: The insufficient number of preserved parathyroid glands is the only cause of hypocalcemia after total thyroidectomy and node dissection. At least one preserved parathyroid gland may prevent postoperative permanent hypocalcemia.

갑상선 전절제술 후 저칼슘혈증을 예측하기 위한 부갑상선호르몬 수치

나안수,김선광,김영욱,윤현조,정성후,Ahn Soo Na,Seon Kwang Kim,Young Wook Kim,Hyun Jo Youn and Sung Hoo Jung 대한갑상선-내분비외과학회 2013 The Koreran journal of Endocrine Surgery Vol.13 No.1

Purpose: The aim of study was to determine the cut-off value of serum parathyroid hormone levels with a predictive value for the occurrence of clinical hypocalcemia following total thyroidectomy. Methods: We performed a retrospective review, of 150 patients who underwent total thyroidectomy for papillary thyroid carcinoma from January 2010 to July 2010. We measured the serum levels of parathyroid hormone and phosphate within 18∼24 hours postoperatively. The serum levels of ionized calcium were measured immediately and within 18∼24 hours postoperatively. We also determined the cut-off value, sensitivity and specificity of serum levels of parathyroid hormone, ionized calcium, and phosphate with a predictive value for the occurrence of clinical hypocalcemia. Results: Serum levels of parathyroid hormone were 2.0±1.7 pg/ml in the clinical hypocalcemia group, 9.9±10.7 pg/ml in the asymptomatic hypocalcemia group, and 15.3±10.7 pg/ml in the normal control group (P<0.001). Serum levels of ionized calcium were also significantly lower in the clinical hypocalcemia group (0.92±0.16 mmol/L) compared with the normal control group (P=0.002). On the other hand, serum levels of phosphate were significantly higher in the clinical hypocalcemia group (P=0.009). The cut-off value of serum parathyroid hormone levels for the prediction of clinical hypocalcemia was 4.5 pg/ml, where the sensitivity, specificity, positive predictive value, and negative predictive value were 87.5%, 63.4%, 89.3% and 59%, respectively. Conclusion: Serum parathyroid hormone levels following total thyroidectomy are the most powerful predictive factors for the occurrence of clinical hypocalcemia. Our results show that the incidence of clinical hypocalcemia is relatively higher at postoperative serum levels of parathyroid hormone ≤4.5 pg/ml.