Assessing Symptomatic Hypocalcemia Risk After Total Thyroidectomy: A Prospective Study

Area of Science:

• Endocrinology
• Surgical Complications
• Clinical Chemistry

Background:

• Hypocalcemia is a frequent complication following total thyroidectomy.
• Current monitoring relies on serum calcium and parathyroid hormone (PTH) levels.

Purpose of the Study:

• Identify precise predictors of postoperative hypocalcemia.
• Develop a risk assessment algorithm.
• Evaluate the utility of calcium correction formulas.

Main Methods:

• Prospective, single-center, non-randomized longitudinal cohort study.
• 205 patients undergoing total thyroidectomy.
• Postoperative sampling of PTH, serum calcium, and ionized calcium.

Main Results:

• First postoperative day PTH is the most sensitive predictor of symptomatic hypocalcemia (80.22% sensitivity, cut-off ≤2.03 pmol/L).
• Combined serum calcium and PTH on day one offered highest sensitivity (94%) and specificity (89%) for predicting hypocalcemia.
• Algorithms and correction formulas did not improve prediction accuracy.

Conclusions:

• First postoperative day PTH is the most sensitive predictor for symptomatic hypocalcemia by day five.
• The clinical utility of complex algorithms and correction formulas for hypocalcemia prediction is limited.