Parathyroid hormone guided protocols for hypocalcemia management after thyroidectomy: A systematic review

Area of Science:

• Endocrinology
• Surgical Oncology
• Internal Medicine

Background:

• Hypocalcemia is a common complication after total thyroidectomy, leading to frequent hospital readmissions.
• Standardized Parathyroid Hormone (PTH)-based protocols offer a structured approach to manage postoperative hypocalcemia.
• Institutional variations in PTH protocols exist, necessitating an evaluation of their effectiveness in reducing hospital visits.

Purpose of the Study:

• To examine institutional variations in Parathyroid Hormone (PTH)-based protocols for postoperative hypocalcemia management.
• To evaluate the effectiveness of these protocols in minimizing unnecessary hospital readmissions and emergency department visits.

Main Methods:

• Systematic review of published PTH-based protocols from multiple institutions.
• Data extraction included hospital stay, PTH and calcium thresholds, supplementation, discharge criteria, and readmission rates.
• Searches were conducted in PubMed, Web of Science, Embase, and Scopus (PROSPERO ID: CRD42024615865).

Main Results:

• Ten protocols met inclusion criteria, predominantly recommending PTH measurement within 4 hours postoperatively.
• Risk stratification used PTH thresholds (10-15 pg/mL), guiding selective calcium and calcitriol supplementation.
• Effective protocols reported low readmission rates (0-7.0%, mostly <1%), with same-day discharge feasible for low-risk patients.

Conclusions:

• PTH-based protocols effectively reduce readmissions following thyroidectomy through early PTH monitoring, risk stratification, and tailored supplementation.
• Standardizing key components of these protocols can enhance patient safety, reduce unnecessary interventions, and standardize care.
• Widespread adoption of evidence-based PTH protocols is recommended to improve postoperative management of hypocalcemia.