J. Y. Liu1, C. J. Weber1, M. McCullough1, J. Sharma1 1Emory University School Of Medicine,General Surgery,Atlanta, GA, USA
Introduction:
The management of hypocalcaemia after total thyroidectomy (TTx) is a challenge as TTx is transitioned into a same-day surgery. Measurement of the parathyroid hormone (PTH) level following TTx allows for prediction of postoperative hypocalcaemia, defined as symptomatic hypocalcaemia or requiring intravenous calcium (IV Ca) supplementation, and may decrease the need for routine serum calcium (Ca) monitoring and lead to shorter hospital stays.
Methods:
After implementing a standardized calcium management protocol based on PTH measurement and routine oral Ca supplementation, a retrospective database was queried to evaluate protocol efficacy and compliance for 169 patients undergoing TTx between 2012 and 2014. This was compared to a previous time period between 2010 and 2012 where 67 patients underwent TTx. Patient demographics, extent of surgery, post-operative laboratory values, complications, IV Ca, and length of stay were analyzed.
Results:
Of the 169 patients undergoing TTx, transient hypocalcaemia (TH) and permanent hypocalcaemia (PH) was reported in 17 and 0 patients respectively (10.1%, 0%). PTH was recorded in 81.7% (n=138) patients with 64.5% (n=89) >10 pg/ml and 35.5% (n=49) <10 pg/ml. In 2012-2014, there was a decrease in length of stay in the PTH<10 group compared to 2010-2012 (Table 1). However, in the PTH>10 group no significant change was observed between the two time periods (Table 1). From 2012-2014, patients with PTH<10 also had fewer calcium lab draws compared to 2010-2012 (Table 1). In the PTH>10 group, 3.4% (n=3) of patients had TH. However, in the PTH<10 group, 34.69% (n=17) of patients had TH. There were three readmissions for TH and all were in patients with PTH<10.
Conclusion:
A PTH<10 can serve as a predictor for TH and readmissions in TTx. The implementation of a single PTH measurement protocol with a standardized calcium regimen has decreased the length of stay and the number of calcium draws for patients undergoing TTx and will make TTx a more cost effective procedure.
