Can Parathyroid Score Expect Hypocalcemia after Total Thyroidectomy?

Jin Hee Park; Ho Yong Park; Jin Hyang Jung; Seung Ook Hwang; Jeeyeon Lee; Taek Ju Kwon; Wan Wook Kim

doi:10.16956/kjes.2015.15.2.34

Journal List > Korean J Endocr Surg > v.15(2) > 1060142

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Park, Park, Jung, Hwang, Lee, Kwon, and Kim: Can Parathyroid Score Expect Hypocalcemia after Total Thyroidectomy?

Original Article

Korean J Endocrine Surg 2015;15(2):34-40.

Published online: 10 December 2015

DOI: https://doi.org/10.16956/kjes.2015.15.2.34

Can Parathyroid Score Expect Hypocalcemia after Total Thyroidectomy?

Jin Hee Park, Ho Yong Park, Jin Hyang Jung, Seung Ook Hwang, Jeeyeon Lee, Taek Ju Kwon, Wan Wook Kim

Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea

Correspondence: Wan Wook Kim Department of Surgery, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu 702-120, Korea Tel: ＋82-53-200-2705 Fax: ＋82-53-200-2027 e-mail: kww1324@naver.com

Received 16 March 2015 Revised 29 April 2015 Accepted 18 May 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aims of this study were to investigate whether parathyroid score can predict hypocalcemia after total thyroidectomy with central lymph node dissection (CLND) and to determine clinical value of parathyroid score for treatment of hypocalcemia.

Methods

A prospective review of 209 patients who underwent total thyroidectomy with CLND for papillary thyroid cancer from January to December 2012 was conducted. Parathyroid score was designed based on the number and color of parathyroid preservation (Save and intact color of a parathyroid was 2; Save but mild discoloration was 1.5; Not identification was 1.2; Autotransplantation was 1.0; Sacrifice was −1).

Results

The mean numbers of parathyroid glands were as follows: save & intact color was 2.0; save & mild discoloration was 0.8; not identification was 0.8; autotransplantation was 0.4. The average parathyroid score was 6.54±0.69 (range 3.4∼8.0). The average PTH was 16.3 at the 1^st POD. Transient and permanent hypocalcemia were 33.4% (70/209) and 0.9% (2/209), respectively. Parathyroid score was 6.78±0.54 in patients without transient hypocalcemia, 5.93±0.67 with hypocalcemia, parathyroid score was significantly lower in transient hypocalcemia, abnormal PTH at the 1^st POD (P＜0.001, P＜0.001).

Conclusion

Parathyroid score may predict patients at risk of developing transient hypocalcemia after total thyroidectomy with CLND.

Keywords: Hypocalcemia, Parathyroid hormone, Parathyroid score, Total thyroidectomy

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Fig. 1.

Gross status of parathyroid gland according to color of it. Surgeon saved parathyroid with intact color (A); parathyroid could be save and it became mild discolored (B); parathyroid could be saved but it became severe discolored (C).

Fig. 2.

Changes of Serum total calcium (A) and ionized calcium (B) level according to postoperative day. Serum total calcium and ionized calcium level were decreased at postoperative #1, 2 days and recovered after postoperative #10 days.

Fig. 3.

ROC (Receiver Operating Characteristic) curve and AUC (Area under the curve) of parathyroid score for transient hypocalcemia.

Fig. 4.

Algorism for calcium supplement based on parathyroid hormone (PTH) at postoperative (POD) #1 day and parathyroid score.

Table 1.

Clinicopathologic characteristics of patients

Characteristics	Total (n=208) (range or %)
Age (years)	49.3±0.8 (15∼77)
≥45	126 (60.6%)
＜45	82 (39.4%)
Gender (male:female)	1:5.9
Tumor size (cm)	0.9±0.1 (0.1∼6.5)
＜1 cm	138 (66.3%)
Multiple tumor	89 (42.8%)
Hashimoto's thyroiditis	45 (21.6%)
Extrathyroidal extension	123 (59.8%)
Central lymph node metastasis	85 (40.9%)
Number of retrieved lymph node (n)	9.5±0.4 (1∼31)
Number of metastatic lymph node (n)	1.3±0.1 (0∼12)
Operation time (min)	103.4±1.3 (68∼230)
Hospital stay (day)	3.3±0.1 (2∼7)
Total drain amount (mL)	114.5±5.1

Table 2.

Parathyroid score based on the preservation and color of parathyroid, mean number of parathyroid

Gross status of parathyroid	Parathyroid score	Mean number of parathyroid	Sum of parathyroid score
Preservation of parathyroid with intact color	2	1.95	3.90
Preservation of parathyroid with mild discoloration	1.5	0.85	1.27
Non-identification of parathyroid	1.2	0.78	0.93
Autotransplantation of parathyroid	1	0.39	0.39
Sacrifice of parathyroid	−1	0.02	−0.02
Sum		4.00	6.54

Table 3.

Comparison parathyroid score according to PTH level, hypocalcemia

Characteristics	Sum of parathyroid score	P value
PTH at POD #1
Normal	6.8±0.5	＜0.001
Abnormal	6.0±0.6
PTH at POD #10
Normal	6.7±0.6	＜0.001
Abnormal	6.3±0.6
Hypocalcemia
No	6.8±0.5
Transient	5.9±0.6	＜0.001
Permanent	6.1±0.11	0.305

PTH = parathyroid hormone; POD = postoperative day.

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