Objective : To evaluate the trend of labs ordered for post-operative total thyroidectomy surgery patients at KUMC and to check if these are consistent with those deemed necessary by the current literature and create a new labs order set to be utilized among post-operative total thyroidectomy surgery patients at KUMC.
Methods : Using HERON databases, we created a search query of adult patients who underwent total thyroidectomy surgery at KUMC during January to December 2017. We identified the labs that were ordered during post-operative period and observed calcium values at time of discharge and subsequent labs following discharge.
Results : Eighty-two eligible individuals with a mean age of 53.5 years (15-83 years) were identified from HERON. Of these, Six patients were excluded from this study, Among 76 patients, benign and malignant thyroid pathology were reported in 56(73.7%) and 20(26.3%) patients, respectively. Most of malignant lesions (60%) were papillary thyroid carcinoma (PTC).Post-operative total calcium level was done in all patients with a mean nadir calcium level of 8.4 mg/dL. However, only 37(48.7%) patients had follow-up calcium checked within 2 weeks following a hospital discharge, there were 3 patients who had calcium-related complications, two of them had hypercalcemia, one with hypocalcemia but none of them required readmission. Parathyroid hormone (PTH) and 25-hydroxy vitamin D (25OHD) level were checked post-operatively in 51(67%) and 32(42.1%) patients, respectively. While, 33(43.4%) patients hadmagnesium level checked and 45(59.2%) patients had follow-up phosphorus level.
Discussion : According to AACE/ACE recommendations, post-operative PTH and serial calcium (and occasionally magnesium) values should be obtained, as well as, appropriate calcium prophylaxis regimens, should be initiated. In our study, we found that there was a significant discrepancy of lab monitoring and management plans regarding postoperative hypocalcemiaamong TT patients in our hospital. Although, no patient required readmission. There were fewpatients that developed calcium-related complications. Two patients developed hypercalcemia at time of follow-up, both were prescribed calcitriol at time of discharge. One patient had hypocalcemia during follow-up. The 25OHD level of this patient was adequate at 31.8 mg/dL.Whereas postoperative PTH level was less than 4 pg/mL but she did not receive calcitriol aftersurgery.
Conclusion : Appropriate guidelines to prevent postoperative hypocalcemia for post-TT patients are needed to reduce calcium-related complications and can be modified based on individual patients. This critical issue can decrease morbidities and mortalities among TT patients.
Siwadon Pitukweerakul– fellow, university of kansas medical center, Kansas City, Kansas
Poemlarp Mekraksakit– Internal Medicine Resident, Texas Tech University Health Sciences Center, Lubbock, Texas
Rudruidee Karnchanasorn– Assistant Professor, University of Kansas Medical Center
university of kansas medical center
Kansas City, Kansas
Internal Medicine Resident
Texas Tech University Health Sciences Center