Predicting pediatric hypocalcemia post-thyroidectomy with intraoperatory PTH: Validation of a proposed algorithm and improvement in hospitalization days.

FREIRE AV; RODRÍGUEZ AZRAK S; PAPENDIECK P; VIEITES A; ELIAS E; RODRÍGUEZ E; BALLERINI MG; BERGADÁ I; ROPELATO MG; CHIESA A

CABA

Congreso; XXVI Annual Meeting SLEP; 2016

Sociedad Latinoamericana de Endocrinología Pediátrica

Background: In a previous report we proposed and algorithm with intraoperatory PTH at 5 and 60 minutes post thyroidectomy (TX) (PTH-5) (PTH-60) for predicting hypocalcemia (Freire et al, Surgery 2015). Objectives: To validate our cut-off values as predictors of hypocalcemia. To evaluate the impact of the propose strategy on:? Reduction on the occurrence of clinical and/or biochemical hypocalcaemia. ? Reduction on the period of hospitalization post TX and serum calcemic controls (sCa+). Methods: Patients were prospectively classified according to their risk of hypocalcaemia in: G1: High risk: PTH-5: ≤16 pg/mL or PTH-5 16?20 pg/ml with PTH-60: ≤16 pg/mL; IV Calcium was infused immediately after TX, 1-25OHVit D and oral Calcium were introduced within 24?48 hs after TX according to oral tolerance. G2: Low risk: PTH-5: >20 pg/mL or PTH-5 16?20 pg/mL with PTH-60: >16 pg/mL, underwent clinical controls of hypocalcemia every 6 h and sCa+ performed when present; sCa+ was checked at 24 and 48 h after TX, if normal, patient was discharged. Presence of signs/symptoms of hypocalcaemia, days of hospitalization and number of sCa+ in low risk patients were recorded and compared with those of our historical thyroidectomized group (HG) (32 patients, 15 with hipocalcemia)*.(PTH assay: ECLIA, COBAS e-411, Roche Diagnostics). Results:21 children, aged (median, range) 12.7 (3.8?19) years, 18 girls) were included. Seven fell in G1 and 14 in G2. Five patients from G1 remained asymptomatic and had transient hypoparathyroidism. The remaining 2 developed mild hypocalcemic symptoms with definitive hypoparathyroidism. None of G2 patients developed hypocalcaemia due to hypoparathyroidism, 1 hyperthyroid girl had mild hypocalcemia related to hungry bone syndrome. Hospitalization lasted 3 (4?6) days in G1, vs. 6 (3?18) days in HG (p < 0.01). G2 remained hospitalized 2 (1?3) days and their sCa+ controls were 2 (1?4) vs. 5 (4?6) in HG (p < 0.001). Conclusions:This study has validated our proposed algorithm to identify patients at risk of hypocalcaemia post TX and allowed avoiding hypocalcaemia, decreasing days of hospitalization and calcemic controls post-TX. Therefore, this strategy consequently reduced health costs related to the surgical procedure.