INVESTIGADORES
BERGADÁ Ignacio
artículos
Título:
Predicting hypocalcemia after thyroidectomy in children
Autor/es:
FREIRE, ANALÍA; ROPELATO, M.G.; BALLERINI MG; ACHA O; BERGADÁ I; GRUÑEIRO PAPENDIECK, L; CHIESA A
Revista:
SURGERY.
Editorial:
MOSBY-ELSEVIER
Referencias:
Lugar: St. Louis; Año: 2014
ISSN:
0039-6060
Resumen:
Background and aims. Hypocalcemia after thyroidectomy is caused by parathyroid trauma. There are no
studies regarding the usefulness of intact parathyroid hormone (PTH) as a monitor of postoperative
hypoparathyroidism tool in pediatrics. We evaluated the diagnostic accuracy of intra- and postoperative
PTH to predict the risk of developing post thyroidectomy hypocalcemia in children.
Methods. A prospective longitudinal cohort study was conducted in 32 pediatric patients (3.2?
17.6 years old) undergoing total thyroidectomy. Intact PTH measured by the assays (Immulite
Immunoassay System [ICMA] or electrochemioluminescence assay [ECLIA]) at 5 (PTH-5) and 60
(PTH-60) minutes after thyroid removal were considered as predicting variables. The postoperative
outcome was hypocalcemia (endpoint variable). Patients were clinically and biochemically monitored
regularly for 48 hours after surgery.
Results. Of the patients, 47% developed hypocalcemia (15% symptomatic). An ICMA PTH-5 of #14
pg/mL or an ECLIA PTH-5 of #16 pg/mL predicted hypocalcemia with a sensitivity of 80%, specificity
of 100%, positive predictive value (PPV) of 100%, and diagnostic efficiency (DE) of 91%. Using the
same cutoff values, PTH-60 presented a sensitivity of 93%, specificity of 82%, PPV of 81%, and DE of
87%. Adjusting for variation in the assays and combining intra- and postoperative PTH
determinations, we developed an algorithm that improved sensitivity, specificity, and DE.
Conclusion. PTH is useful for predicting hypocalcemia after total thyroidectomy in children. The use of
our proposed strategy should be considered to (a) initiate preventive treatment in patients identified at
high risk for hypocalcemia, (b) shorten the duration of hospitalization, and (c) reduce the clinical and
biochemical controls in those who remained normocalcemic. (Surgery 2014;156:130-6.)