Risk factors for central neck lymph node metastasis of clinically noninvasive,node-negative papillary thyroid microcarcinoma

Background

To examine predictive factors for subclinical central neck lymph node metastases (LNM) of papillary thyroid microcarcinoma (PTMC).

Methods

The clinical and pathological findings of 287 patients with clinically noninvasive, node-negative, solitary papillary thyroid carcinoma (PTC), who had undergone thyroidectomy plus central compartment neck dissection and showed pathologically confirmed nodal metastases, were analyzed. Predictive risk factors for central LNM were quantified.

Results

Pathologic LNM was identified in 63 (32.6%) PTMC patients and 48 (51.0%) PTC patients (tumor size >1 cm; P = .003). Tumor size (>.7 cm; P = .011), multifocality (P = .010), and microscopic extracapsular extension (P = .050) were significant variables predictive of central LNM from PTMC in univariate analysis. Tumor size (odds ratio 2.28, 95% confidence interval 1.19 to 4.38; P = .014) and multifocality (odds ratio 2.38, 95% confidence interval 1.14 to 4.93; P = .020) were independent variables predictive of central LNM in multivariate analysis.

Conclusions

Cervical LNM is highly prevalent in clinically noninvasive, node-negative PTC. Central neck LNM is associated with larger tumor size and multifocality of PTMC.     

Thyroglobulin antibodies as a potential predictive marker of papillary thyroid carcinoma in patients with indeterminate cytology

Backround

We investigated the efficacy of thyroglobulin antibodies (TgAb) in detecting malignancy in indeterminate thyroid nodules and evaluated the possible association between TgAb and autoimmunity in papillary thyroid carcinoma (PTC).

Methods

This retrospective, nonrandomized study included 1,646 patients who had undergone preoperative fine-needle aspiration biopsy to evaluate their thyroid nodules, and then standard total thyroidectomy. Of 194 patients (11.8%) with indeterminate nodules, 61 (31.4%) had PTC and 133 (68.6%) had benign nodules at the final histologic examination.

Results

Univariate analysis showed that multifocality (P = .002), bilaterality (P = .003), lymph-node metastasis (P = .030), and capsule penetration (P = .003) were significantly associated with positive TgAb in patients with indeterminate cytology and histopathologic diagnosis of PTC. The multivariate analysis showed that TgAb positivity (P < .001) and preoperative thyroid-stimulating hormone levels (P = .022) were independent predictive factor for PTC diagnosis in patients with indeterminate cytology.

Conclusions

Preoperative TgAb could be a marker for PTC in patients with indeterminate thyroid nodules, increasing diagnostic accuracy. TgAb positivity could also influence the clinical assessment and subsequent selection of total thyroidectomy.     

Contralateral papillary thyroid cancer: does size matter?

Background

The optimal extent of thyroidectomy for papillary thyroid cancer (PTC) <1 cm is controversial. Our aim was to identify the rate and factors predictive of contralateral PTC in these patients.

Methods

We examined 228 patients with PTC who underwent either completion or total thyroidectomy and analyzed the predictive value of tumor size, histology, margin status, capsular invasion, extrathyroid extension, multifocality, and node metastases.

Results

We observed no differences in the rate of contralateral disease in patients with primary PTC ≥1 cm compared with those having disease <1 cm, 30% versus 24%, respectively (P = .43). Multifocality was the only factor predictive of contralateral PTC in patients with tumors <1 cm (P = .02). Patients with tumors <.5 cm also had a comparable rate of contralateral disease (27%).

Conclusions

The presence of contralateral PTC appears to be unrelated to the size of the primary tumor. Furthermore, in patients with PTC <1 cm, multifocality is a risk factor for PTC in the contralateral lobe.     

Thymosin beta 10 correlates with lymph node metastases of papillary thyroid carcinoma

Background

Thymosin beta 10 (TMSB10) has recently been recognized as being an important player in the metastatic cascade including tumor angiogenesis, invasion, and metastasis. However, a role for this protein in papillary thyroid carcinoma (PTC) has not yet been established.

Methods

Real-time polymerase chain reaction was used to examine the expression of TMSB10 messenger RNA in 36 cases of thyroid tissue samples: normal thyroid, PTC without lymph node metastases (LNM) and PTC with LNM (n = 12 cases in each subgroup). For immunohistochemistry, 130 patients with PTC were selected during the period of 2004–2005, 91 with and 39 without LNM. Statistical analysis was applied to evaluate the correlation between TMSB10 expression and LNM of PTC.

Results

By real-time polymerase chain reaction analysis, the expression of TMSB10 messenger RNA in normal thyroid tissue, PTC without LNM, and PTC with LNM tissue were significantly different (P < 0.0001). On immunohistochemistry analysis of 130 patients with PTC, in which 91 cases had cervical LNM and 69 cases had central neck LNM, high expression levels for TMSB10 were more common in patients with cervical LNM compared with patients without (81% versus 33%, P < 0.001). Similarly, high expression levels of TMSB10 were more common in patients with central neck LNM compared with those without (87.0% versus 44.3%, P < 0.001).

Conclusions

High expression levels of TMSB10 correlated with LNM in PTC, especially in the central neck region. Patients with PTC with low levels of TMSB10 expression may be unlikely to have central neck LNM and could therefore avoid prophylactic central neck dissection.     

Papillary thyroid carcinoma in children: risk factors and complications of disease recurrence

Introduction

Optimal treatment of recurrent papillary thyroid carcinoma (PTC) in children remains controversial. We reviewed our experience with recurrent PTC to better identify children diagnosed with it.

Aims

The objective of this study was to determine the risk factors, optimal treatment, complications, and prognosis of recurrent PTC in children.

Methods

This is a retrospective review of all thyroid resections for children aged 18 years or younger who have PTC at a single institution from 1987 to 1999.

Results

Thirty-six children, 7 boys (19%) and 29 girls (81%), underwent initial cervical exploration for PTC. Lymph node involvement was noted in 25 patients (69%); however, there was no distal disease. An equal number of children underwent subtotal thyroidectomy (n = 18) and total (n = 18) thyroidectomy as their initial operation. Papillary thyroid carcinoma recurrences developed in 17 patients (47%) a median of 7 months (range, 1-43 months) after their initial operation. Recurrence was more common for patients with lymph node involvement (P < .01) and multiple nodules (P < .05) at presentation. Recurrence developed in 5 patients after subtotal thyroidectomy and in 12 patients after total thyroidectomy. Sixteen children with recurrent PTC had a second operation and 6 required a third operation. Total operative complications included 2 patients with permanent hypocalcemia and 1 patient with permanent recurrent laryngeal nerve injury, all of whom had a total thyroidectomy. No patient died; however, 3 continue to harbor disease. Mean follow-up for patients with PTC was 65 months (range, 15 to 144 months).

Conclusions

Thyroid resection combined with selective use of radioactive iodine ablation is a safe and effective treatment for recurrent PTC in children. The best predictors of this recurrent disease are lymph node involvement and multiple thyroid nodules at presentation.     

Time interval in diagnosis and treatment of papillary thyroid cancer: a descriptive, retrospective study

Background

Studies have investigated delays in the diagnosis of neoplasms to identify delays to treatment on the part of patients and primary care practitioners. The aim of the current study was to evaluate the time interval (TI) required for the diagnosis of symptomatic papillary thyroid carcinoma (PTC).

Methods

The study included 97 patients with PTC. Other histologic types and incidental microcarcinomas were excluded. The primary outcome variable was the TI between the occurrence of a sign/symptom and thyroidectomy. TI was composed of: patient's TI (PTI), diagnostic TI (DTI), and therapeutic TI (TTI).

Results

The TI between the occurrence of a sign/symptom and thyroidectomy averaged 3 months. PTI ranged from 25-85 days, DTI from 12-40 days, and TTI from 7-30 days. PTI was higher (P < .05) than DTI and TTI.

Conclusion

PTI is the most important factor affecting TI. Implementation of information may increase patient's alertness and reduce misinterpretation of signs/symptoms. Collaboration between specialists is fundamental to further reduce DTI and TTI.     

Global variation in the pattern of differentiated thyroid cancer

Background

The prevalence of differentiated thyroid cancer (DTC) is increasing worldwide. Iodine deficiency is a risk factor for follicular thyroid cancer (FTC). We compared DTC subtypes in an iodine-deficient country with a developed country.

Methods

A retrospective review of thyroid cancer at tertiary centers in West Africa and the United States. All patients diagnosed with thyroid cancer from 1980 to 2004 were retrieved from the West African Center's Cancer Registry Database. The study period was divided into two groups: 1980 to 1989 and 1990 to 2004. In the American center, a review of patients undergoing surgery for thyroid cancer from 1997 to 2008 was performed.

Results

At the African institution, 322 patients underwent thyroidectomy for cancer from 1980 to 2004. Overall, 31.5% had papillary thyroid cancer (PTC), and 30.3% had FTC. From 1980 to 1989, 27.3% had PTC and 35.8% had FTC. From 1990 to 2004, 35.7% had PTC and 24.8% had FTC. At the American institution, 105 patients underwent surgery for thyroid cancer from 1997 to 2008; 79% had PTC and 7.6% had FTC.

Conclusions

FTC is still common in developing countries, whereas PTC is the predominant subtype in developed countries. Efforts to decrease iodine deficiency may improve outcomes by changing to a less aggressive subtype.     

Distinguishing classical papillary thyroid microcancers from follicular-variant microcancers

Background

Papillary thyroid microcarcinomas (mPTCs), tumors less than or equal to 1 cm, have been considered the same clinical entity as microfollicular-variant papillary thyroid microcarcinomas (mFVPTCs). The purpose of this study was to use population-level data to characterize differences between mFVPTC and mPTC.

Materials and methods

We identified adult patients diagnosed with mFVPTC or mPTC between 1998 and 2010 in the Surveillance, Epidemiology, and End Results database. Binary comparisons were made with the Student t-test and chi-squared test. Multivariate logistic regression was used to further analyze lymph node metastases and multifocality.

Results

Of the 30,926 cases, 8697 (28.1%) were mFVPTC. Multifocal tumors occurred with greater frequency in the mFVPTC group compared with the mPTC group (35.4% versus 31.7%; P < 0.01). Multivariate logistic regression indicated that patients with mFVPTC had a 26% increased risk of multifocality (odds ratio, 1.26; 95% confidence interval, 1.2–1.4; P < 0.01). In contrast, lymph node metastases were nearly twice as common in the mPTC group compared with the mFVPTC group (6.8% versus 3.6%; P < 0.01). Multivariate logistic regression confirmed that patients with mPTC had a 69% increased risk of lymph node metastases compared with patients with mFVPTC (odds ratio, 1.69; 95% confidence interval, 1.4–2.0; P < 0.01).

Conclusions

Multifocality is not unique to classical mPTC and occurs more often in mFVPTC. The risk of lymph node metastases is greater for mPTC than mFVPTC. The surgeon should be aware of these features as they may influence the treatment for these microcarcinomas.     

Quality of life after thyroid surgery in women with benign euthyroid goiter: influencing factors including Hashimoto's thyroiditis

Background

Hashimoto's thyroiditis is associated with decreased quality of life (QoL). Thyroid surgery could hypothetically lead to an increase in QoL.

Methods

In a follow-up analysis of a prospective cohort study that included euthyroid women undergoing thyroid surgery for benign thyroid disease, 248 patients were willing to answer the SF-36 QoL questionnaire.

Results

At follow-up after a median of 26 months, only the SF-36 module of “bodily pain” had increased (P = .046). Preoperative anti–thyroid peroxidase antibody levels were positively correlated with increasing QoL in the SF-36 modules “bodily pain” (P < .001) and “role emotional” (P < .001). For the presence of histologically confirmed Hashimoto's thyroiditis, a significant positive correlation (P < .001) was found for all modules apart from “physical functioning.”

Conclusions

In women with benign euthyroid goiter, thyroid surgery does not lead to an overall improvement in health-related QoL. It should not be recommended for patients with elevated anti–thyroid peroxidase antibody levels. Patients with histologically confirmed Hashimoto's thyroiditis might benefit in terms of QoL.     

Epidermal growth factor receptor overexpression is a marker for adverse pathologic features in papillary thyroid carcinoma

Background

Epidermal growth factor receptor (EGFR) overexpression (EGFR-H) is implicated in thyroid carcinoma disease progression; however, the clinicopathologic significance of EGFR-H in tumors that harbor EGFR and/or v-Raf murine sarcoma viral oncogene homolog B1 (BRAF)(V600E) mutations is unknown.

Methods

Tissue microarrays from 81 patients who had undergone thyroidectomy for carcinoma from 2002–2011 were scored for EGFR expression using immunohistochemistry. Somatic mutations in EGFR exons 19 and 21 and BRAF were analyzed. Correlations between the EGFR immunohistochemistry, EGFR, and BRAF(V600E) mutations and the clinicopathologic features were assessed.

Results

EGFR-H was detected in 39.5% of carcinomas (n = 32) from patients with papillary (PTC, 46.2%, n = 18), follicular (29.6%, n = 8), and anaplastic (100.0%, n = 6) but not medullary (0.0%, n = 9) thyroid carcinoma. BRAF(V600E) mutations were identified in 22.2% of the carcinoma cases (n = 18, 15 PTCs and 3 anaplastic thyroid carcinomas). No somatic EGFR mutations were detected in any subtype. On PTC univariate analysis, EGFR-H correlated with increasing stage, extrathyroid extension, tumor capsule invasion, adverse pathologic features (any demonstration of extrathyroid extension, tumor capsule invasion, lymphovascular invasion, lymph node metastasis, and/or distant metastasis), and BRAF(V600E) mutations. On multivariate analysis, EGFR-H correlated with BRAF(V600E) mutations. In BRAF wild-type PTCs, the correlation between EGFR-H and adverse pathologic features approached statistical significance (P = 0.065).

Conclusions

EGFR-H could be an important biomarker for aggressive PTCs, particularly in BRAF wild-type PTCs. Despite EGFR-H in PTC, follicular thyroid carcinoma, and anaplastic thyroid carcinoma by immunohistochemistry, somatic EGFR mutations were absent. Therefore, future investigations of EGFR should consider histologic and immunohistochemical methods, in addition to molecular profiling of thyroid carcinomas. This multimodal approach is particularly important for future clinical trials testing anti-EGFR therapy.     

MicroRNA-21 regulates biological behaviors in papillary thyroid carcinoma by targeting programmed cell death 4

Background

Our recent study has found that microRNA-21 (miRNA-21) was significantly upregulated in papillary thyroid carcinoma (PTC) tissues compared with nontumor tissues by using miRNA microarray chip. However, the function of miRNA-21 is unknown in PTC. The aim of this study was to investigate the roles of miRNA-21 in PTC and the mechanism of gene regulation by it.

Methods

We transfected PTC cell line (TPC-1) with pEZX-eGFP-miRNA-21 plasmid to determine the biological functions of miRNA-21. Western blot assay was applied to investigate the correlation between miRNA-21 and programmed cell death 4 (PDCD4) expression in TPC-1 cell line.

Results

Overexpression of miRNA-21 could significantly enhance proliferation and invasion and inhibit the apoptosis of TPC-1 cells. In addition, miRNA-21 and PDCD4 expression showed a significantly negative correlation in TPC-1 cells.

Conclusions

These data suggest that miRNA-21 may play an oncogenic role by directly targeting PDCD4 in the cellular processes of PTC. In addition, the findings in our present study also may represent new clues for the diagnostic and therapeutic strategies in the treatment of PTC.     

Multifocality in well-differentiated thyroid carcinomas calls for total thyroidectomy

Background

Multifocality is an important factor when recommending surgery for papillary thyroid cancer (PTC). The aim of this study is to assess the incidence and characterize the spread pattern of multifocal PTC (mPTC) in patients undergoing total thyroidectomy.

Methods

All thyroidectomies performed between 2003 and 2008 were reviewed identifying 289 patients. Data were obtained for demographics, clinical data, and histopathological findings.

Results

Of the patients with papillary carcinoma, mPTC was identified in 150 patients (57%), of which 71% had lesions in the contralateral lobe. There were no significant differences in multifocality rate for gender, pathology type, and all tumor size subgroups including ≤1 cm. Pathology examination of representative sections versus the entire gland examination resulted in a significantly lower incidence of contralateral disease (P = .04).

Conclusions

Multifocal and contralateral lesions are common in PTC and their incidence is not related to tumor size. Pathology entire gland examination is strongly recommended to properly assess the rate of mPTC.     

A systematic review and meta-analysis comparing outcomes between robotic-assisted thyroidectomy and non-robotic endoscopic thyroidectomy

Background

Despite its feasibility, using the da Vinci robot in remote-access thyroidectomy remains controversial. This meta-analysis compared surgical and oncological outcomes between robotic-assisted thyroidectomy (RT) and non-robotic endoscopic thyroidectomy (ET).

Methods

A systematic review was performed to identify studies comparing outcomes between RT and ET. Outcomes included operating time, drain output, complications, number of central lymph nodes retrieved, and preablation stimulated thyroglobulin level. A random-effects model was used.

Results

Six studies were eligible. Of the 3510 patients, 2167 (61.7%) underwent RT whereas 1343 (38.3%) underwent ET. Despite a higher drain output (185.8 mLs versus 173.3 mLs, P = 0.019), RT had fewer temporary recurrent laryngeal nerve injury (2.6% versus 3.3%, P = 0.035) and shorter length of hospital stay (3.4 d versus 3.5 d, P = 0.030). In terms of oncological outcomes, despite higher incidence of multicentricity and larger tumors, the number of central lymph nodes retrieved during unilateral central neck dissection in RT was significantly greater than ET (4.5 ± 2.6 and 3.4 ± 2.5, P < 0.001) whereas the preablation stimulated thyroglobulin was comparable (0.8 ng/mL versus 1.1 ng/mL, P = 0.456). However, follow-up data were relatively scarce.

Conclusions

Adding the robot in remote-access thyroidectomy was associated with a significantly lower risk of temporary recurrent laryngeal nerve injury and shorter length of hospital stay. However, despite achieving a comparable level of surgical completeness for low-risk differentiated thyroid carcinoma between RT and ET, this study highlighted the limitations with the current literature and the need for more prospective studies with adequate follow-up.     

Thyroid lobectomy is not sufficient for T2 papillary thyroid cancers

Background

Histologic subtypes of papillary thyroid cancer affect prognosis. The objective of this study was to examine whether survival is affected by extent of surgery for conventional versus follicular-variant papillary thyroid cancer when stratified by tumor size.

Co-occurrence of papillary thyroid cancer and MALT lymphoma of the thyroid with severe airway obstruction: A case report and review of the literature

INTRODUCTION

Co-occurrence of papillary thyroid carcinoma (PTC) and mucosa-associated lymphoid tissue (MALT) lymphoma resulting in severe airway obstruction is very rare.

PRESENTATION OF CASE

A 58-year-old woman visited our department because of enlargement of a neck mass. Computed tomography (CT) and ultrasonography showed 2 discrete hypoechoic nodules. Fine-needle aspiration biopsy revealed thyroid lymphoma in the left lobe and PTC in the right lobe. After 1 week, she returned to the emergency room at our hospital with shortness of breath and difficultly in swallowing. CT revealed enlargement of the left lobe, which was severely compressing the trachea. We performed emergency total thyroidectomy with lymphadenectomy. The postoperative course was uneventful, and the patient was discharged without any symptoms.

DISCUSSION

The most common treatment for PTC is surgery; however, the treatment for thyroid lymphoma remains controversial. We propose that surgery be performed in the cases of symptoms such as shortness of breath and difficulty in swallowing.

CONCLUSION

We performed emergency total thyroidectomy to relieve obstruction of the trachea and to remove the two malignant tumors. We suggest total thyroidectomy for a case of co-occurrence of two malignant tumors, causing severe airway obstruction.     

Oncologic outcomes of robotic thyroidectomy: 5-year experience with propensity score matching

Background

The oncologic outcome of robotic thyroidectomy is not yet well established. The aim of this study was to evaluate the recurrence rate after robotic thyroidectomy in comparison with conventional thyroidectomy for papillary thyroid carcinoma (PTC).

Methods

We analyzed 896 patients with PTC who either underwent robotic (212 patients using a gasless unilateral axillary or an axillo-breast approach) or conventional cervical thyroidectomy (684 patients) with/without central neck dissection between October 2008 and February 2014. We excluded patients who underwent concomitant lateral neck dissection or completion thyroidectomy, and cases with T4 tumor, tumor lager than 4 cm, other types of thyroid cancer, recurrent cancer, and distant metastasis. A propensity score matching analysis was done with ten covariates including age, gender, body mass index, tumor size, multifocality, bilaterality, extrathyroidal extension, type of thyroidectomy, extent of central neck dissection, and RAI ablation to reduce selection bias.

Results

In baseline data, the male ratio and the mean age were lower in the robotic group. Stage, multifocality, and bilaterality were higher in the conventional group. The rate of total thyroidectomy was higher in the conventional group. The two matched groups of each 185 patients were produced and well balanced by propensity score matching. In the comparison of propensity score matched groups, operative time was longer in the robotic group (P < 0.001), and postoperative complications did not differ between the two groups, except for transient hypoparathyroidism and formation of seroma. The recurrence rate did not differ between the two groups after a mean follow-up of 43.6 months (0.5 and 1.1 % in the robotic and conventional groups, respectively, P = 0.375).

Conclusion

The oncologic outcome of robotic thyroidectomy in 5-year experience is comparable to that of conventional thyroidectomy in selected patients with PTC.

     

Comparison of surgical outcomes between papillary thyroid cancer patients treated with the Harmonic ACE scalpel and LigaSure Precise instrument during conventional thyroidectomy: a single-blind prospective randomized controlled trial

Background

The aim of this study was to evaluate the safety and efficacy of thyroidectomy using the Harmonic ACE scalpel (HS) or the LigaSure Precise (LS) instrument in conventional thyroidectomy.

Materials and methods

A prospective, randomized controlled trial was performed. Between August 2011 and June 2012, 832 patients who required thyroidectomy for papillary thyroid cancer were randomized into groups treated with either the HS or the LS instrument. Operative time and surgical morbidities were analyzed.

Results

A total of 320 patients (HS group, N = 164; LS instrument group, N = 156) were randomized for analysis according to the intention-to-treat principle. There were no statistically significant differences in the operative times (HS group versus LS instrument group: 71.93 ± 18.26 versus 75.15 ± 20.13; P = 0.423), postoperative transient hypoparathyroidism (13.4% versus 14.1%; P = 0.858), and permanent recurrent laryngeal nerve injuries between the two groups.

Conclusions

In this study, both hemostatic devices were safe and effective in terms of postoperative results and complications without any differences.     

Synchronous multifocal medullary and papillary thyroid microcarcinoma detected by elastography

INTRODUCTION

A few cases of concomitant medullary and papillary carcinoma in the same thyroid nodule have been described in the literature. However, the presence of multiple foci of both types of malignancy in the same gland is very rare.

PRESENTATION OF CASE

A 39 year-old female with multiple thyroid nodules, elevated serum calcitonin levels and elastographic findings suggestive of thyroid malignancy, underwent total thyroidectomy and central neck dissection. Histology revealed the presence of one focus of medullary and one focus of papillary carcinoma on each thyroid lobe. Subsequently, the patient underwent treatment with radioactive iodine.

DISCUSSION

This is the third case of synchronous multifocal medullary and papillary thyroid carcinoma reported in the literature. Several theories for the simultaneous development of these malignant entities have been proposed.

CONCLUSION

Ultrasound elastography can be a useful, noninvasive tool in the assessment of thyroid nodules.     

Sex variability of fine-needle aspiration reliability in the diagnosis of malignancy in thyroid nodules ≥4 cm

Background

The effect of sex on fine-needle aspiration (FNA) diagnosis of thyroid cancer remains unknown. This study determines the reliability of FNA when evaluating thyroid nodules ≥4 cm in women and men.

Methods

Prospectively collected data of 1,068 patients who underwent FNA and thyroidectomy at a tertiary medical center were retrospectively reviewed. Data were stratified by sex and thyroid nodule size ≥4 cm.

Results

The FNA false-negative rate for thyroid malignancy in women and men was 17% and 0%, respectively. FNA was less predictive of malignancy in women (odd ratio = 31.7; 95% confidence interval, 19.2 to 52.5; P < .0001) compared with men (odds ratio = 51.7; 95% confidence interval, 11.8 to 225.1; P < .0001) with thyroid nodules ≥4 cm.

Conclusions

For the diagnosis of malignancy in large thyroid nodules, FNA may be less reliable in women compared with men. This study advocates using a more aggressive approach that includes surgical resection for definitive diagnosis in women with thyroid nodules ≥4 cm.     

Perioperative indicators of hypocalcemia in total thyroidectomy: the role of vitamin D and parathyroid hormone

Background

Hypocalcemia is a common complication of thyroidectomy. The aim of this study was to identify risk factors for this problem.

Methods

This prospective analysis included 111 patients undergoing total or completion thyroidectomy. Preoperative vitamin D levels and postoperative day 1 parathyroid hormone levels were analyzed for their predictive effects on postoperative hypocalcemia.

Results

Patients with ionized calcium <4.4 mg/dL had significantly lower mean parathyroid hormone levels than normocalcemic patients (13.0 vs 28.4 pg/mL, P < .001). Parathyroid hormone levels were also significantly lower in symptomatic patients (11.0 vs 28.4 pg/mL, P < .001). Preoperative vitamin D level, body mass index, gender, and pathologic findings were not associated with low calcium levels or symptoms of hypocalcemia.

Conclusions

Younger age and low postoperative parathyroid hormone levels are predictive of symptomatic hypocalcemia. A parathyroid hormone level outside of the reference range may indicate a need for more aggressive postoperative calcium supplementation and treatment with activated vitamin D. Older patients with normal postoperative parathyroid hormone levels may be safely discharged with appropriate calcium supplementation.