Korean J Endocr Surg.  2015 Jun;15(2):34-40. 10.16956/kaes.2015.15.2.34.

Can Parathyroid Score Expect Hypocalcemia after Total Thyroidectomy?

• Park JH
• Park HY
• Jung JH
• Hwang SO
• Lee J
• Kwon TJ
• Kim WW

• KMID: 2144003
• DOI: http://doi.org/10.16956/kaes.2015.15.2.34

Abstract

PURPOSE
The aims of this study were to investigate whether parathyroid score can predict hypocalcemia after total thyroidectomy with central lymph node dissection (CLND) and to determine clinical value of parathyroid score for treatment of hypocalcemia.
METHODS
A prospective review of 209 patients who underwent total thyroidectomy with CLND for papillary thyroid cancer from January to December 2012 was conducted. Parathyroid score was designed based on the number and color of parathyroid preservation (Save and intact color of a parathyroid was 2; Save but mild discoloration was 1.5; Not identification was 1.2; Autotransplantation was 1.0; Sacrifice was -1).
RESULTS
The mean numbers of parathyroid glands were as follows: save & intact color was 2.0; save & mild discoloration was 0.8; not identification was 0.8; autotransplantation was 0.4. The average parathyroid score was 6.54+/-0.69 (range 3.4~8.0). The average PTH was 16.3 at the 1st POD. Transient and permanent hypocalcemia were 33.4% (70/209) and 0.9% (2/209), respectively. Parathyroid score was 6.78+/-0.54 in patients without transient hypocalcemia, 5.93+/-0.67 with hypocalcemia, parathyroid score was significantly lower in transient hypocalcemia, abnormal PTH at the 1st POD (P<0.001, P<0.001).
CONCLUSION
Parathyroid score may predict patients at risk of developing transient hypocalcemia after total thyroidectomy with CLND.

Keyword

Hypocalcemia; Parathyroid hormone; Parathyroid score; Total thyroidectomy

MeSH Terms

Autografts
Humans
Hypocalcemia*
Lymph Node Excision
Parathyroid Glands
Parathyroid Hormone
Prospective Studies
Thyroid Neoplasms
Thyroidectomy*
Parathyroid Hormone

Figure

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  Fig. 1. Gross status of parathyroid gland according to color of it. Surgeon saved parathyroid with intact color (A); parathyroid could be save and it became mild discolored (B); parathyroid could be saved but it became severe discolored (C).

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  Fig. 2. Changes of Serum total calcium (A) and ionized calcium (B) level according to postoperative day. Serum total calcium and ionized calcium level were decreased at postoperative #1, 2 days and recovered after postoperative #10 days.

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  Fig. 3. ROC (Receiver Operating Characteristic) curve and AUC (Area under the curve) of parathyroid score for transient hypocalcemia.

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  Fig. 4. Algorism for calcium supplement based on parathyroid hormone (PTH) at postoperative (POD) #1 day and parathyroid score.

Reference

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