Recovery room pth levels can facilitate safe calcium management after thyroidectomy for graves' disease

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The use of early postoperative parathyroid hormone (PTH) levels to help guide calcium management after thyroid surgery has been demonstrated to be an effective approach. However, no studies have investigated this method specifically for patients undergoing surgery for hyperthyroidism, who because of a greater rate of hypoparathyroidism and the potential compounding influence of hungry bone syndrome are at particular risk for significant hypocalcemia. This study examines the safety of utilizing recovery room (RR) PTH levels to stratify these patients and to dictate the post-operative calcium regimen. Patients who underwent total thyroidectomy for hyperthyroidism by a single endocrine surgeon were retrospectively examined. Patient demographics, use of intraoperative PTH postoperatively, post-operative calcium regimen, and post-operative complications, including hypoparathyroidism and emergency department (ED) visits were analyzed. During the study period 48 patients underwent total thyroidectomy for hyperthyroidism. Of these, 32 patients had a RR PTH obtained post-operatively. Due to sufficient PTH levels, 19 patients were discharged with no calcium supplementation and 13 (including 7 with undetectable PTH levels) were provided a supplementation regimen that included calcium ± calcitriol due to their low PTH. None of the 25 patients with detectable or normal PTH levels returned to the ED. Of those with undetectable PTH levels, 2/7 came to the ED with acute hypocalcemic symptoms (p < 0.05). In comparison, 1/16 patients who did not have a RR PTH and who universally were managed with calcium (only) supplementation had a post-operative ED visit. Only 1 patient (2.1%) of the overall cohort experienced permanent hypoparathyroidism. Using RR PTH to determine post-operative calcium management after a total thyroidectomy for hyperthyroidism is safe and results in few returns to the ED. However, patients with undetectable PTH levels are at markedly greater risk of developing symptoms requiring an ED visit. Surgeons should consider these risks when determining ambulatory status following surgery.



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