Assessing Postoperative Phosphate and Calcium/Phosphate Ratio as Surrogates for Parathyroid Hormone Following Total Thyroidectomy
© 2024 American Academy of Otolaryngology-Head and Neck Surgery Foundation..
OBJECTIVE: Evaluate utility of postoperative phosphate and calcium/phosphate ratio (Ca/P) as surrogates for parathyroid hormone (PTH) following total thyroidectomy.
STUDY DESIGN: Retrospective cohort study.
SETTING: Tertiary care hospital.
METHODS: We retrospectively reviewed patients 18 years or older who underwent total thyroidectomy in a tertiary care hospital by a single surgeon from 2015 through 2021. Patients with incomplete data, pre-existing hypoparathyroidism, vitamin D deficiency, or renal failure were excluded. All patients had PTH drawn within 4 hours of surgery and serum calcium, albumin, and phosphate levels on postoperative Day 1. Corrected calcium was used to calculate a Ca/P. Receiver operating characteristic (ROC) curves were generated to compare phosphate level or Ca/P with PTH. Each possible surrogate was assessed relative to PTH cutoffs of less than 5, 10, 15, and 20 pg/mL. A good screening test was defined as having an area under the curve (AUC) greater than 0.8.
RESULTS: A total of 185 patients underwent total thyroidectomy with 1 fellowship-trained otolaryngologist. Most patients were female (62%), median age 48 years. Most surgeries were performed for cancer (68%). Six (3.2%) patients required IV calcium supplementation and 2 (1.1%) required readmission for symptomatic hypocalcemia. ROC curves comparing phosphate and Ca/P to PTH at the listed cutoffs demonstrated AUC ranging from 0.55 to 0.66 and 0.61 to 0.79, respectively. None met the threshold for a good screening test.
CONCLUSION: Postoperative phosphate and Ca/P ratio are not surrogates for PTH levels following total thyroidectomy. More research is needed to identify cost-effective strategies for postoperative calcium monitoring in patients undergoing total thyroidectomy.
LEVEL OF EVIDENCE: Retrospective cohort study.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery - (2024) vom: 14. März |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kappauf, Catharine [VerfasserIn] |
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| Links: |
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| Themen: |
Ca/P ratio |
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| Anmerkungen: |
Date Revised 14.03.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1002/ohn.703 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369727355 |
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| 100 | 1 | |a Kappauf, Catharine |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Assessing Postoperative Phosphate and Calcium/Phosphate Ratio as Surrogates for Parathyroid Hormone Following Total Thyroidectomy |
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| 500 | |a Date Revised 14.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © 2024 American Academy of Otolaryngology-Head and Neck Surgery Foundation. | ||
| 520 | |a OBJECTIVE: Evaluate utility of postoperative phosphate and calcium/phosphate ratio (Ca/P) as surrogates for parathyroid hormone (PTH) following total thyroidectomy | ||
| 520 | |a STUDY DESIGN: Retrospective cohort study | ||
| 520 | |a SETTING: Tertiary care hospital | ||
| 520 | |a METHODS: We retrospectively reviewed patients 18 years or older who underwent total thyroidectomy in a tertiary care hospital by a single surgeon from 2015 through 2021. Patients with incomplete data, pre-existing hypoparathyroidism, vitamin D deficiency, or renal failure were excluded. All patients had PTH drawn within 4 hours of surgery and serum calcium, albumin, and phosphate levels on postoperative Day 1. Corrected calcium was used to calculate a Ca/P. Receiver operating characteristic (ROC) curves were generated to compare phosphate level or Ca/P with PTH. Each possible surrogate was assessed relative to PTH cutoffs of less than 5, 10, 15, and 20 pg/mL. A good screening test was defined as having an area under the curve (AUC) greater than 0.8 | ||
| 520 | |a RESULTS: A total of 185 patients underwent total thyroidectomy with 1 fellowship-trained otolaryngologist. Most patients were female (62%), median age 48 years. Most surgeries were performed for cancer (68%). Six (3.2%) patients required IV calcium supplementation and 2 (1.1%) required readmission for symptomatic hypocalcemia. ROC curves comparing phosphate and Ca/P to PTH at the listed cutoffs demonstrated AUC ranging from 0.55 to 0.66 and 0.61 to 0.79, respectively. None met the threshold for a good screening test | ||
| 520 | |a CONCLUSION: Postoperative phosphate and Ca/P ratio are not surrogates for PTH levels following total thyroidectomy. More research is needed to identify cost-effective strategies for postoperative calcium monitoring in patients undergoing total thyroidectomy | ||
| 520 | |a LEVEL OF EVIDENCE: Retrospective cohort study | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Ca/P ratio | |
| 650 | 4 | |a calcium | |
| 650 | 4 | |a hypocalcemia | |
| 650 | 4 | |a hypoparathyroidism | |
| 650 | 4 | |a phosphate | |
| 650 | 4 | |a thyroidectomy | |
| 700 | 1 | |a Gold, Brandon |e verfasserin |4 aut | |
| 700 | 1 | |a Gonzalez-Velazquez, Camilo |e verfasserin |4 aut | |
| 700 | 1 | |a Xing, Monica H |e verfasserin |4 aut | |
| 700 | 1 | |a O'Malley, Quinn F |e verfasserin |4 aut | |
| 700 | 1 | |a Sandler, Mykayla |e verfasserin |4 aut | |
| 700 | 1 | |a Chai, Raymond L |e verfasserin |4 aut | |
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