Abstract
Objective
To determine if routine rapid intact parathyroid hormone (PTH) testing in the post-anesthesia care unit (PACU) would reduce post-thyroidectomy hypocalcemia.
Methods
Controlled cohort study comparing mean serum calcium and rate of hypocalcemia on postoperative day 1 (POD1) following total or completion thyroidectomy by a single surgeon. The control group consists of 133 subjects undergoing surgery between 2003–2005 prior to availability of rapid PTH testing for whom calcium and vitamin D supplementation was instituted only if patients developed hypocalcemia (calcium<8.0mg/dl) postoperatively. The routine PACU PTH group consists of 169 subjects undergoing surgery between 2006–2007 with routine PACU PTH testing for whom calcium and vitamin D supplementation was instituted for PACU PTH < 15 or subsequent development of hypocalcemia.
Results
Mean serum calcium corrected for albumin was significantly lower in the control group than the routine PACU PTH group on POD1 (8.2 vs 8.6, p<0.0001). The rate of hypocalcemia on POD1 was higher in the control group than the routine PACU PTH group (35% vs. 14%, p<0.0001).
Conclusions
Routine PACU PTH testing and early calcium and vitamin D supplementation for patients with hypoparathyroidism significantly reduced the proportion of patients experiencing hypocalcemia following total or completion thyroidectomy.