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Change in post-thyroidectomy PTH, calcium levels linked to permanent hypoparathyroidism

Issue: June 2018

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Steven L. Brown

BOSTON — Postoperative change in serum levels of calcium and parathyroid hormone from before surgery might help predict which patients are at risk for developing permanent hypoparathyroidism following total thyroidectomy, according to study findings presented at the American Association of Clinical Endocrinologists annual meeting.

“Predicting patients at risk for permanent hypoparathyroidism is key to managing postoperative patients, and it’s very important to draw both preoperative labs and also postoperative labs in order to help predict those patients who are at risk,” Steven L. Brown, DO, endocrinology fellow at the University of Arizona College of Medicine, Phoenix, said during the presentation.

Brown and colleagues conducted a retrospective chart review of 250 patients with thyroid cancer (215 women; mean age, 52 years; 101 white; 11 black; 115 Hispanic) who underwent total thyroidectomy between 1999 and 2013 to determine predictors of permanent hypoparathyroidism. Permanent hypoparathyroidism was defined as persistent PTH level less than 12 pg/mL and calcium level less than 8 mg/dL or requiring calcitriol to maintain normal calcium level for at least 6 months following surgery. The researchers included 176 patients in the final analysis.

The incidence of permanent hypoparathyroidism was 17%, with no differences relative to sex, age or race between those who did or did not develop the condition.

Greater postoperative decreases from presurgical levels were observed in both PTH and calcium among patients who developed permanent hypoparathyroidism vs. those who did not, with a 69.7% drop in PTH vs. 29.7% (P = .016) and a 17.7% drop in calcium vs. 14.3% (P = .042), respectively. Patients with both postoperative low PTH and low calcium were more likely than those with a normal level of at least one measure to develop permanent hypoparathyroidism (P = .0007). Among the cohort, 30.3% of those with low values for both measures and 19.4% of those with low calcium and normal PTH developed permanent hypoparathyroidism compared with 10% of those with low PTH and normal calcium and 2% with normal levels of both. Baseline levels of PTH, calcium or vitamin D were not associated with permanent hypoparathyroidism.

“Calculating percent change [in PTH and calcium levels], which we don’t typically do after surgery, can assist us in predicting those patients in order to get the right patients on the right medications for the right duration of time after surgery,” Brown said. – by Jill Rollet

Reference:

Brown SD, et al. Abstract 720. Presented at: AACE Annual Scientific and Clinical Congress; May 16-20, 2018; Boston.

Disclosure: Brown reports no relevant financial disclosures.