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Hypoparathyroidism

Early postoperative calcium and PTH levels predict hypoparathyroidism risk

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Ionized calcium levels on the first postoperative day (POD-1) are the most accurate predictor of postoperative hypocalcemia (PoHC), while low parathyroid hormone (PTH) levels on POD-1 indicate a higher risk for permanent hypoparathyroidism (PtHPT), according to a study.

The retrospective analysis involved 200 patients and examined serum and ionized calcium, as well as PTH levels.

Results showed that 46% of patients developed PoHC on POD-1, while THPT and PtHPT were observed in 37% and 9% of cases, respectively. Ionized calcium levels below 4.43 mg/dL on POD-1 emerged as the most accurate predictor of PoHC (AUC = 0.9), outperforming both serum calcium and PTH levels. For PtHPT, a PTH level below 8.06 pg/mL showed predictive value (AUC = 0.797).

Multivariate analysis further highlighted PTH < 21.2 pg/mL, ionized calcium < 4.43 mg/dL, and serum calcium < 8.76 mg/dL on POD-1 as significant risk factors for PoHC.

Reference
Sánchez-Canteli M, Pasarón-Canga M, Riestra-Fermández M, et al. Ionized calcium and PTH as predictors of hypoparathyroidism following total thyroidectomy. Eur Arch Otorhinolaryngol. 2025;doi: 10.1007/s00405-025-09205-2. Epub ahead of print. PMID: 39849077.

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