Issue N# 2 - 2018
HEAD AND NECK
How to predict post thyroidectomy hypocalcaemia with early PTH assay? A prospective study
Authors : Hervochon R. (Saint Germain en Laye)
Ref. : Rev Laryngol Otol Rhinol. 2018;139,2:27-31.
Article published in english 
Downloadable PDF document english
Summary :
Aim: The aim of this study was to assess early post operative Parathyroid Hormone (PTH) assay as a predictor of day-one hypocalcaemia after total thyroidectomy. Material and Methods: Post-operative PTH assays were performed 1 hour (PTHh1) and 4 hours (PTHh4) after thyroid removal. Day-one hypocalcaemia was defined as having corrected total serum calcium lower than 2.0 mmol/l. We calculated R-ratio: Post operative PTH/preoperative PTH and used ROC-curves. Objectives: The objective was to define the best predictive factor of day-one hypocalcaemia. Results: Ten of 109 patients presented hypocalcaemia at day-one (9.2%). Area under ROC-curves for PTHh1, PTHh4, R-PTHh1 and R-PTHh4 did not significantly differ (0.81; 0.80; 0.78 and 0.79; p >0.05). Thresholds were respectively: 19.5 mmol/l, 13.5 mmol/l, 0.38, and 0.37. All tests had sensitivities of 100%. Greatest Positive Predictive Value was 28% for PTHh4, versus 21% for the others. Patients with PTHh4 <13.5 mmol/l belonged to a «high risk of hypocalcaemia» group, whose corrected total serum calcium kinetics was decreasing the days after, contrary to other patients. Conclusion: Our results did not demonstrate any benefit in measuring a pre-operative PTH to detect post-operative hypocalcaemia. A single PTH assay sampled at h4 with a threshold of 13.5 ng/L seems to be the best and reliable tool.
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