Prognostic significance of intraoperative pth test for the development of post-thyroidectomy hypocalcaemia

Abstract

ABSTRACT The high incidence of postoperative hypoparathyroidism after total thyroidectomy and the significant morbidity associated with it can account for the sustained efforts to find reliable, affordable markers for the prognosis of this condition. Therefore, a lot of attention has been paid recently to the perioperative measurement of the parathyroid hormone (PTH) as an immediate indicator showing the parathyroid glands functional status. There are a lot of studies in the relevant literature demonstrating that PTH is a highly sensitive marker, with high specificity to predict development of postoperative hypocalcemia. Recent studies analyze in-depth not only the absolute values of PTH, but also the dynamics of its levels during surgery. The number and timing of sampling for testing is a matter of discussion. Importance is attached also to the hormone testing methods. Research results determine intraoperative PTH (IOPTH) as a valuable additional test for early risk assessment of hypocalcaemia allowing prevention and timely treatment of patients at risk. Early identifi cation of risk groups of patients creates a real opportunity to reduce the incidence of this complication by autotransplantation of parathyroid glands. Despite the encouraging results the predictive accuracy of this indicator is not 100%, which requires careful result interpretation. The fi ndings of researchers are not uniform, probably due to differences in study design, the methods used in PTH testing, and the accepted reference range of serum calcium. This impedes comparison of data and highlights the need for similar analyzes in each specialized center.