Journal List > Korean J Endocr Surg > v.15(3) > 1060148

Lee, Kim, Lim, Shin, Cho, Jung, Jung, Kim, Jeong, Choi, Han, and Hur: Factors Predicting Hypocalcemia after Total Thyroidectomy with Central Lymph Node Dissection in Papillary Thyroid Cancer

Abstract

Purpose

Total thyroidectomy with central lymph node dissection (CLND) is a treatment modality of choice for thyroid cancer. Hypocalcemia is the most common complication after total thyroidectomy. The aim of the current study was to determine the association between surgery-related clinical factors and postoperative hypocalcemia.

Methods

A prospective analysis was performed for 101 patients who underwent total thyroidectomy with CLND for papillary cancer from June 2013 to June 2014. Correlation between clinicopathologic factors and postoperative hypocalcemia was analyzed.

Results

Based on the postoperative day-2 calcium, 56 patients (55%) developed hypocalcemia and 45 patients (45%) were normal. No significant differences in histopathologic (tumor size, tumor focality, histologic type, number of retrieved lymph nodes, metastatic lymph node, thyroiditis, retrieved parathyroid gland) findings were observed between the hypocalcemia group and normal calcium group. Mean value of the postoperative day-0 parathyroid hormone (PTH) was significantly lower in the hypocalcemia group (hypoca1cemia group: 14.3±9.4 pg/mL; normal group: 25.0±16.4 pg/mL; P<0.001). In logistic regression analysis, postoperative PTH was a factor significantly affecting postoperative hypocalcemia (OR 0.93; CI: 0.90-0.97; P<0.001). In ROC analysis, the cut-off value of PTH was 19.965 (sensitivity 79%, specificity 58%), and area under the curve (AUC) was 0.709 (95% CI: 0.607-0.811).

Conclusion

Postoperative PTH was a factor predicting hypocalcemia after total thyroidectomy with CLND. Use of postoperative PTH as a screening tool for prediction of postoperative hypocalcemia would be useful in management of patients with hypocalcemia.

Figures and Tables

Fig. 1

Area under curve (AUC) of postoperative parathyroid hormone for postoperative hypocalcemia.

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Fig. 2

Change of parathyroid hormone between hypocalcemia and normal group.

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Table 1

Comparison of characteristics between hypocalcemic and normocalcemic patients

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SD = standard deviation; ETE = extra-thyroidal extension; LN = lymph node; Ca = calcium; PTH = parathyroid hormone.

Table 2

Logistic regression analysis for hypocalcemia

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ETE = extra-thyroidal extension; LN = lymph node; Ca = calcium; OR = odds ratio; CI = confidence interval; NA = not available; H-L = Hosmer-Lemeshow; DF = degree of freedom.

Table 3

Receiver Operating Characteristic (ROC) analysis of postoperative parathyroid hormone for hypocalcemia

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PTH = parathyroid hormone; SEN = sensitivity; SPE = specificity; ACC = accuracy; PPV = positive predictive value; NPV = negative predictive value; AUC = area under the curve; CI = confidence interval. *The thresholds were computed by Youden's index.

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