Category: Thyroid

Monitor: 35

35 - EVALUATION AND PREVENTION OF POST-THYROIDECTOMY HYPOCALCEMIA

Thursday, Apr 25
11:30 AM – 12:00 PM

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.

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Siwadon Pitukweerakul

fellow
university of kansas medical center
Kansas City, Kansas

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Poemlarp Mekraksakit

Internal Medicine Resident
Texas Tech University Health Sciences Center
Lubbock, Texas

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Rudruidee Karnchanasorn

Assistant Professor
University of Kansas Medical Center

Assistant professor at University of Kansas Medical Center.