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Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy

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PACU PTH facilitates safe outpatient total thyroidectomy.

Jeffrey J Houlton¹, William Pechter, David L Steward

¹Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio 45267-0528, USA. houltojy@ucmail.uc.edu

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery

|April 16, 2011

Summary

A parathyroid hormone (PTH)-based discharge algorithm safely enables same-day outpatient thyroidectomy. This approach minimizes the risk of hypocalcemia after total or completion thyroidectomy.

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Area of Science:

Endocrinology
Surgical Oncology
Minimally Invasive Surgery

Background:

Total thyroidectomy is a common surgical procedure.
Postoperative hypocalcemia is a significant concern following thyroidectomy.
Current discharge protocols often require prolonged observation.

Purpose of the Study:

To evaluate the safety and efficacy of a serum parathyroid hormone (PTH)-based discharge algorithm for facilitating outpatient total thyroidectomy.
To determine if PTH levels can reliably predict the risk of hypocalcemia in patients discharged on the same day.

Main Methods:

A retrospective case series of 180 patients undergoing total or completion thyroidectomy.
Utilized a same-day discharge algorithm based on rapid postanesthesia care unit serum PTH levels.

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Patients with PTH >30 pg/mL discharged without supplementation; PTH 20-30 pg/mL received calcium supplementation; PTH <20 pg/mL observed overnight.

Main Results:

76% of patients met the PTH discharge criterion (>20 pg/mL).
69% of eligible patients were discharged same-day (53.1% of total cohort).
No outpatient hypocalcemia events occurred among 95 discharged patients; all patients were eucalcemic at follow-up, with no hypoparathyroidism at 30 days.

Conclusions:

A PTH-based discharge algorithm is a safe and effective strategy for facilitating outpatient total and completion thyroidectomy.
This protocol significantly reduces the risk of clinically relevant outpatient hypocalcemia.
The algorithm allows for safe same-day discharge in a majority of thyroidectomy patients.