Abstract
Hypocalcemia is a common complication after total thyroidectomy. In these patients, the serum parathyroid hormone (PTH), calcium level decreases, and the phosphorus level increases. The level of fibroblast growth factor-23 (FGF-23), a phosphaturic hormone, increases in the serum to normalize the phosphorus level. In our study, we aimed to investigate the predictive value of PTH, calcium, phosphorus, 1,25-dihydroxy vitamin D (vitamin D), and FGF-23 tests in revealing patients who will develop hypocalcemia after thyroidectomy. Fifty-seven patients undergoing total thyroidectomy (fifty-two with multinodular goiter, three with Graves’ disease and two with papillary thyroid cancer) were included in this prospective study. Serum PTH, calcium, phosphorus, and vitamin D levels of the patients were measured preoperatively. Ten minutes after complete removal of the thyroid gland, intraoperative PTH (IOPTH) level was measured and the amount of decline in PTH level (PTH decline) was calculated. Postoperative PTH, calcium, phosphorus, vitamin D, and FGF-23 levels were measured 24 h after the operation. Postoperatively, hypocalcemia developed in 7 (12.3%) of the 57 patients. IOPTH, postoperative PTH, calcium, and vitamin D levels were significantly lower and PTH decline was significantly higher in patients with postoperative hypocalcemia. Postoperative FGF-23 levels were similar between the groups (p 0.952). When the IOPTH and postoperative serum calcium values were evaluated together, the highest sensitivity and positive predictive values were obtained (93.5% and 67.5%, respectively), The postoperative FGF-23 test was found to be rather unsatisfactory to reveal development of hypocalcemia (sensitivity of 14.3%). The success of detecting patients with hypocalcemia was highest when IOPTH and postoperative serum calcium levels were evaluated together. The FGF-23 measurements were found to be not sufficient in identifying hypocalcemic patients after total thyroidectomy.
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References
Erbil Y, Barbaros U, Temel B et al (2009) The impact of age, vitamin D(3) level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy. Am J Surg 197(4):439–446
Marcinkowska M, Sniecikowska B, Zygmunt A, Brzezinski J, Dedecjus M, Lewinski A (2017) Postoperative hypoparathyroidism in patients after total thyroidectomy–retrospective analysis. Neuroendocrinol Lett 38(7):488–494
Hosseni M, Otaghyar HA, Tizmaghz A et al (2016) Evaluating the time interval for presenting the signs of hypocalcemia after thyroidectomy. J Clin Diagn Res 10(3):19–22
Pisanu A, Saba A, Coghe F, Uccheddu A (2013) Early prediction of hypocalcemia following total thyroidectomy using combined intact parathyroid hormone and serum calcium measurement. Langenbeck's Arch Surg 398(3):423–430
Grodski S, Serpell J (2008) Evidence for the role of perioperative PTH measurement after total thyroidectomy as a predictor of hypocalcemia. World J Surg 32(7):1367–1373
Gulluoglu B, Manukyan MN, Cingi A et al (2005) Early prediction of normocalcemia after thyroid surgery. World J Surg 29:1288–1293
Kalyoncu D, Gönüllü D, Gedik ML et al (2013) Analysis of the factors that have an effect on hypocalcemia following thyroidectomy. UlusCerrahiDerg 29(4):171–176
Cho JN, Park WS, Min SY (2016) Predictors and risk factors of hypoparathyroidism after total thyroidectomy. Int J Surg 34:47–52
Yamashita H, Yamazaki Y, Hasegawa H et al (2007) Fibroblast growth factor-23 (FGF-23) in patients with transient hypoparathyroidism: its important role in serum phosphate regulation. Endocr J 54(3):465–470
Yamashita H, Yamazaki Y, Hasegawa H, Yamashita T, Fukumoto S, Shigematsu T, Kazama JJ, Fukagawa M, Noguchi S (2005) Fibroblast growth factor-23 in patients with Graves’ disease before and after antithyroid therapy: its important role in serum phosphate regulation. J Clin Endocrinol Metab 90(7):4211–4215
Gracia-Iguacel C, Gonzalez-Parra E, Rodriguez-Osorio L, Sanz AB, Almaden Y, de la Piedra C, Egido J, Rodriguez M, Ortiz A (2013) Correction of hypocalcemia allows optimal recruitment of FGF-23-dependent phosphaturic mechanisms in acute hyperphosphatemia post-phosphate enema. J Bone Miner Metab 31:703–707
Mace LM, Gravesen E, Nordholm A et al (2018) Fibroblast growth factor (FGF) 23 regulates the plasma levels of parathyroid hormone ın vivo through the FGF receptor in normocalcemia, but not in hypocalcemia. Calcif Tissue Int 102:85–92
Gupta A, Winer K, Econs MJ, Marx SJ, Collins MT (2004) FGF-23 is elevated by chronic hyperphosphatemia. J Clin Endocrinol Metab 89(9):4489–4492
Paek SH, Lee YM, Min SY, Kim SW, Chung KW, Youn YK (2013) Risk factors of hypoparathyroidism following total thyroidectomy for thyroid cancer. World J Surg 37(1):94–101
Hermann M, Ott J, Promberger R, Kober F, Karik M, Freissmuth M (2008) Kinetics of serum parathyroid hormone during and after thyroid surgery. Br J Surg 95(12):1480–1487
Stedman T, Chew P, Truran P, Lim CB, Balasubramanian SP (2018) Modification validation and implementation of a protocol for post-thyroidectomy hypocalcaemia. Ann R Coll Surg Engl 100:135–139
Alía P, Moreno P, Rigo R et al (2007) Postresection parathyroid hormone and parathyroid hormone decline accurately predict hypocalcemia after thyroidectomy. Am J Clin Pathol 127(4):592–597
Wiseman JE, Mossanen M, Ituarte PH et al (2010) An algorithm in formed by the parathyroid hormone level reduces hypocalcemic complications of thyroidectomy. World J Surg 34(3):532–537
David V, Dai B, Martin A, Huang J, Han X, Quarles LD (2013) Calcium regulates FGF-23 expression in bone. Endocrinology 154(12):4469–4482
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Peker, Y., Cin, N., Kar, H. et al. Prospective Evaluation of Perioperative Biochemical Tests to Predict Hypocalcemia After Total Thyroidectomy. Indian J Surg 82, 187–190 (2020). https://doi.org/10.1007/s12262-019-01926-z
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DOI: https://doi.org/10.1007/s12262-019-01926-z