Systematic Review of Predicting Hypocalcemia by Detecting Parathyroid Hormone at Different Time after Thyroi-dectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 AHATIYeermaike , MUERTIZAHalimulati , AJIHANHaerman ,  MAGAOWEIYASailike

Department of Vascular Thyroid Surgery, Gastrointestinal Vascular Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China;

Corresponding author：

MAGAOWEIYASailike, Email: sairike@126.com

Keywords：

Thyroidectomy; Hypocalcemia; Parathyroid hormone; Predictive factor

DOI：

10.7507/1007-9424.20140075

Video：

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Objective To evaluate the value of parathyroid hormone (PTH) in predicting hypocalcemia at different time after thyroidectomy. Methods The literatures in CBM, WanFang, CNKI, VIP in Chinese, and OVID, PUBMED, EMBASE, and MEDLINE in English were searched. Hand searches and additional searches were also conducted. The studies of predicting hypocalcemia after thyroidectomy by detecting postoperative PTH at different time were selected, and the quality and tested the heterogeneity of included articles were assessed. Then the proper effect model to calculate pooled weighted sensitivity (SEN), specificity (SPE), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were selected. The summary receiver operating characteristic (SROC) curve was performed and the area under the curve (AUC) was computed. Results Twenty-three articles entered this systematic review, 21 articles were English and 2 articles were Chinese. Fifteen of 23 articles were designed to be prospective cohort study (PC) and 8 of 23 articles were retrospective study (Retro). These articles were divided into two groups. Group 1 was the studies of detecting postoperative PTH in 1 hour, which included 2 012 cases (494 of them occurred hypocalcemia). Group 2 was the studies of detecting postoperative PTH between 4-12 hours, which included 693 cases (266 of them occurred hypocalcemia). The publication bias of 2 groups were smaller that founded through the literature funnel. Meta analysis showed that in addition to merge SEN, between the 2 groups with merge SPE, LR+, LR-, and AUC differences were statistically significant (P < 0.01);the forecast effect of group 1 was better than group 2, and the AUC was the largest area when the PTH value in 1 hour after operation was below 16 ng/L. Conclusion Detection of postoperative PTH value is an effective method for predicting postoperative hypocalcemia. The 1 hour after operation for detecting PTH value below 16 ng/L to predict postoperative hypocalcemia have the best effect.

Citation： AHATIYeermaike, MUERTIZAHalimulati, AJIHANHaerman, MAGAOWEIYASailike. Systematic Review of Predicting Hypocalcemia by Detecting Parathyroid Hormone at Different Time after Thyroi-dectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(3): 318-324. doi: 10.7507/1007-9424.20140075 Copy

1.	Gac EP, Cabané TP, Amat VJ, et al. Incidence of hypocalcemia after total thyroidectomy[J]. Rev Med Chil, 2007, 135(1):26-30.
2.	Lam A, Kerr PD. Parathyroid hormone:an early predictor of postthyroidectomy hypocalcemia[J]. Laryngoscope, 2003, 113(12):2196-2200.
3.	Vescan A, Witterick I, Freeman J. Parathyroid hormone as a predictor of hypocalcemia after thyroidectomy[J]. Laryngoscope, 2005, 115(12):2105-2108.
4.	Soon PS, Magarey CJ, Campbell P, et al. Serum intact parathyroid hormone as a predictor of hypocalcaemia after total thyoidectomy[J]. ANZ J Surg, 2005, 75(11):977-980.
5.	Bozec A, Guevara N, Bailleux S, et al. Early PTH assay after total thyroidectomy:predictive factor for post operative hypocal-cemia?[J]. Rev Laryngol Otol Rhinol (Bord), 2006, 127(3):141-144.
6.	Khafif A, Pivoarov A, Medina JE, et al. Parathyroid hormone:a sensitive predictor of hypocalcemia following total thyroidectomy[J]. Otolaryngol Head Neck Surg, 2006, 134(6):907-910.
7.	McLeod IK, Arciero C, Noordzij JP, et al. The use of rapid para-thyroid hormone assay in predicting postoperative hypocalcemia after total or completionthyroidectomy[J]. Thyroid, 2006, 16(3):259-265.
8.	Wong C, Price S, Scott-Coombes D. Hypocalcaemia and parathyroid hormone assay following total thyroidectomy:predicting the future[J]. World J Surg, 2006, 30(5):825-832.
9.	Chindavijak S. Prediction of hypocalcemia in postoperative total thyroidectomy using single measurement of intra-operative parath-yroid hormone level[J]. J Med Assoc Thai, 2007, 90(6):1167-1171.
10.	Alía P, Moreno P, Rigo R, et al. Postresection parathyroid hor-mone and parathyroid hormone decline accurately predict hypocal-cemia after thyroidectomy[J]. Am J Clin Pathol, 2007, 127(4):592-597.
11.	胡晓磊, 陈力平, 巢琳, 等.甲状旁腺素测定用于预测甲状腺手术后低钙血症的价值分析[J].中国实用外科杂志, 2008, 28(3):189-191.
12.	Graff AT, Miller FR, Roehm CE, et al. Predicting hypocalcemia after total thyroidectomy:parathyroid hormone level vs. serial calcium levels[J]. Ear Nose Throat J, 2010, 89(9):462-465.
13.	Proczko-Markuszewska M, Kobiela J, Stefaniak T, et al. Posto-perative PTH measurement as a predictor of hypocalcaemia after thyroidectomy[J]. Acta Chir Belg, 2010, 110(1):40-44.
14.	王公明.甲状腺围术期血清甲状旁腺素的变化及其与甲状腺术后低钙血症的关系研究[J].中国全科医学, 2011, 14(5A):1449-1450.
15.	Lang BH, Yih PC, Ng KK. A prospective evaluation of quick intraoperative parathyroid hormone assay at the time of skin closure in predicting clinically relevant hypocalcemia after thyroidectomy[J]. World J Surg, 2012, 36(6):1300-1306.
16.	Vanderlei FA, Vieira JG, Hojaij FC, et al. Parathyroid hormone:an early predictor of symptomatic hypocalcemia after total thyroi-dectomy[J]. Arq Bras Endocrinol Metab, 2012, 56(3):168-172.
17.	Islam MS, Sultana T, Paul D, et al. Intraoperative serum parath-yroid hormone level is an indicator of hypocalcaemia in total thyr-oidectomy patients[J]. Bangladesh Med Res Counc Bull, 2012, 38(3):84-89.
18.	Lombardi CP, Raffaelli M, Princi P, et al. Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurement[J]. Surgery, 2004, 136(6):1236-1241.
19.	Sywak MS, Palazzo FF, Teh M, et al. Parathyroid hormone assay predicts hypocalcaemia after total thyroidectomy[J]. ANZ J Surg, 2007, 77(8):667-670.
20.	Grodski S, Farrell S. Early postoperative PTH levels as a predictor of hypocalcaemia and facilitating safe early discharge after total thyroidectomy[J]. Asian J Surg, 2007, 30(3):178-182.
21.	Fahad Al-Dhahri S, Al-Ghonaim YA, Sulieman Terkawi A. Accu-racy of postthyroidectomy parathyroid hormone and corrected calcium levels as early predictors of clinical hypocalcemia[J]. J Otolaryngol Head Neck Surg, 2010, 39(4):342-348.
22.	Graciano AJ, Chone CT, Fischer CA. Applicability of imediate, late or serial intact parathyroid hormone measurement following total thyroidectomy[J]. Braz J Otorhinolaryngol, 2012, 78(5):78-82.
23.	Lecerf P, Orry D, Perrodeau E, et al. Parathyroid hormone dec-line 4 hours after total thyroidectomy accurately predicts hypocalcemia[J]. Surgery, 2012, 152(5):863-868.
24.	Kim JP, Park JJ, Son HY, et al. Effectiveness of an i-PTH mea-surement in predicting post thyroidectomy hypocalcemia:prospe-ctive controlled study[J]. Yonsei Med J, 2013, 54(3):637-642.
25.	Chapman DB, French CC, Leng X, et al. Parathyroid hormone early percent change:an individualized approach to predict postthyroidectomy hypocalcemia[J]. Am J Otolaryngol, 2012, 33(2):216-220.
26.	李洲成, 申志刚, 吕冬, 等.甲状腺切除术后低钙血症相关因素分析[J].医学临床研究, 2008, 25(8):1441-1442.

1. Gac EP, Cabané TP, Amat VJ, et al. Incidence of hypocalcemia after total thyroidectomy[J]. Rev Med Chil, 2007, 135(1):26-30.
2. Lam A, Kerr PD. Parathyroid hormone:an early predictor of postthyroidectomy hypocalcemia[J]. Laryngoscope, 2003, 113(12):2196-2200.
3. Vescan A, Witterick I, Freeman J. Parathyroid hormone as a predictor of hypocalcemia after thyroidectomy[J]. Laryngoscope, 2005, 115(12):2105-2108.
4. Soon PS, Magarey CJ, Campbell P, et al. Serum intact parathyroid hormone as a predictor of hypocalcaemia after total thyoidectomy[J]. ANZ J Surg, 2005, 75(11):977-980.
5. Bozec A, Guevara N, Bailleux S, et al. Early PTH assay after total thyroidectomy:predictive factor for post operative hypocal-cemia?[J]. Rev Laryngol Otol Rhinol (Bord), 2006, 127(3):141-144.
6. Khafif A, Pivoarov A, Medina JE, et al. Parathyroid hormone:a sensitive predictor of hypocalcemia following total thyroidectomy[J]. Otolaryngol Head Neck Surg, 2006, 134(6):907-910.
7. McLeod IK, Arciero C, Noordzij JP, et al. The use of rapid para-thyroid hormone assay in predicting postoperative hypocalcemia after total or completionthyroidectomy[J]. Thyroid, 2006, 16(3):259-265.
8. Wong C, Price S, Scott-Coombes D. Hypocalcaemia and parathyroid hormone assay following total thyroidectomy:predicting the future[J]. World J Surg, 2006, 30(5):825-832.
9. Chindavijak S. Prediction of hypocalcemia in postoperative total thyroidectomy using single measurement of intra-operative parath-yroid hormone level[J]. J Med Assoc Thai, 2007, 90(6):1167-1171.
10. Alía P, Moreno P, Rigo R, et al. Postresection parathyroid hor-mone and parathyroid hormone decline accurately predict hypocal-cemia after thyroidectomy[J]. Am J Clin Pathol, 2007, 127(4):592-597.
11. 胡晓磊, 陈力平, 巢琳, 等.甲状旁腺素测定用于预测甲状腺手术后低钙血症的价值分析[J].中国实用外科杂志, 2008, 28(3):189-191.
12. Graff AT, Miller FR, Roehm CE, et al. Predicting hypocalcemia after total thyroidectomy:parathyroid hormone level vs. serial calcium levels[J]. Ear Nose Throat J, 2010, 89(9):462-465.
13. Proczko-Markuszewska M, Kobiela J, Stefaniak T, et al. Posto-perative PTH measurement as a predictor of hypocalcaemia after thyroidectomy[J]. Acta Chir Belg, 2010, 110(1):40-44.
14. 王公明.甲状腺围术期血清甲状旁腺素的变化及其与甲状腺术后低钙血症的关系研究[J].中国全科医学, 2011, 14(5A):1449-1450.
15. Lang BH, Yih PC, Ng KK. A prospective evaluation of quick intraoperative parathyroid hormone assay at the time of skin closure in predicting clinically relevant hypocalcemia after thyroidectomy[J]. World J Surg, 2012, 36(6):1300-1306.
16. Vanderlei FA, Vieira JG, Hojaij FC, et al. Parathyroid hormone:an early predictor of symptomatic hypocalcemia after total thyroi-dectomy[J]. Arq Bras Endocrinol Metab, 2012, 56(3):168-172.
17. Islam MS, Sultana T, Paul D, et al. Intraoperative serum parath-yroid hormone level is an indicator of hypocalcaemia in total thyr-oidectomy patients[J]. Bangladesh Med Res Counc Bull, 2012, 38(3):84-89.
18. Lombardi CP, Raffaelli M, Princi P, et al. Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurement[J]. Surgery, 2004, 136(6):1236-1241.
19. Sywak MS, Palazzo FF, Teh M, et al. Parathyroid hormone assay predicts hypocalcaemia after total thyroidectomy[J]. ANZ J Surg, 2007, 77(8):667-670.
20. Grodski S, Farrell S. Early postoperative PTH levels as a predictor of hypocalcaemia and facilitating safe early discharge after total thyroidectomy[J]. Asian J Surg, 2007, 30(3):178-182.
21. Fahad Al-Dhahri S, Al-Ghonaim YA, Sulieman Terkawi A. Accu-racy of postthyroidectomy parathyroid hormone and corrected calcium levels as early predictors of clinical hypocalcemia[J]. J Otolaryngol Head Neck Surg, 2010, 39(4):342-348.
22. Graciano AJ, Chone CT, Fischer CA. Applicability of imediate, late or serial intact parathyroid hormone measurement following total thyroidectomy[J]. Braz J Otorhinolaryngol, 2012, 78(5):78-82.
23. Lecerf P, Orry D, Perrodeau E, et al. Parathyroid hormone dec-line 4 hours after total thyroidectomy accurately predicts hypocalcemia[J]. Surgery, 2012, 152(5):863-868.
24. Kim JP, Park JJ, Son HY, et al. Effectiveness of an i-PTH mea-surement in predicting post thyroidectomy hypocalcemia:prospe-ctive controlled study[J]. Yonsei Med J, 2013, 54(3):637-642.
25. Chapman DB, French CC, Leng X, et al. Parathyroid hormone early percent change:an individualized approach to predict postthyroidectomy hypocalcemia[J]. Am J Otolaryngol, 2012, 33(2):216-220.
26. 李洲成, 申志刚, 吕冬, 等.甲状腺切除术后低钙血症相关因素分析[J].医学临床研究, 2008, 25(8):1441-1442.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Systematic Review of Predicting Hypocalcemia by Detecting Parathyroid Hormone at Different Time after Thyroi-dectomy

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