I think the best way is to check on the operative list to look for the surgeons' names!!!!

Indeed, however even experienced surgeons have transitory hypoparas...

In my opinion, conditions involving severe autoimmune inflammation (Hashimoto´s thyroiditis) are more difficult to opperate. Among my patients, most of those with persistent postoperative hypoparathyroidism or NLR-palsy had Hashimoto´s thyroiditis (and were operated for progressive thyroid nodules or suspicious FNAB). But the most important issue is for sure the expertise of the surgeon - therefore, we refer the patients to only a few surgeons operating in the largest faculty centres (and only selected hospitals).

I totaly agree, but after operating don't you want to have an evaluation of the parathyroid function?

Of course, we always check the calcium-phosphate parameters after the operation (I mean - when the patient arrives to the outpatient department and still is hypoparathyroid, I am not talking about the quick transient forms during hospitalisations in surgery).

If hypoparathyroidism occurrs, we treat it, but we try to detract the medication after some months to see whether the function recovered.

This is what I was talking about. We are developing a scale to predict transient hypopara

But I guess the transient is really common ( I mean the super-transient - during hospitalisation in surgery) - more interesting would be to predict the permanent - or maybe we are talking about the same thing...

I could imagine to include some patients after operation into a follow-up study - and e.g. correlate the preoperative degree of TPOAb positivity, thyroid ultrasound hypoechogenity, presence of multiple nodules with postoperative Ca, P e.g. in 2 wks postop., 1 month, 3 months and 6 months - something like that should be feasible for the routine practice.

There is currently not a reliable algorithm to help surgeons determine who will be at risk for hypocalcemia. However, vitamin D and parathyroid hormone are known to regulate calcium levels and these levels soon after surgery may be useful in differentiating who will be at risk. There is a small number of studies that look at the association between vitamin D and PTH levels and the risk of hypocalcemia. Particularly, to determine if this information can be compiled to create an algorithm to help surgeons manage patients post-operatively.

This is an interesting topic. I think the crux of the matter is how to differentiate between transient "reactive" hypocalcaemia and permanent parathyroid damage. For the uncommon patients who has symptomatic hypocalcaemia and started on replacement therapy, I find it difficult to stop medication and test their status once they have left hospital. It would be impractical to monitor calcium levels frequently and symptoms would be distressing for patients in the community.

I totally agree

Yes i totally agree to your proposal.

It would be very interesting to have tools helping us with the anticipation of hypocalcaemia, but the studydesign, as mentioned, would be a difficult one.

The study design is not so difficult. Given the fact that the incidence of hypopara is low a sample of about 500 thyroidectomies shoulde be ok

We are currently undergoing a similar study where we are examining postoperative vit D and PTH levels and looking at their relationship with postop hypoCa. When we performed the initial analysis, after examining 300 patients, we found that Vit D had no relationship to hypoca.. .that was an interesting finding. and that patients with a PTH level of over than 30 can be safely discharged, as over 90% of them were euthyroid and the ones who did develop hypoCa with a PTH of over 30 were managed with a low dose of Ca supp for a short time... again the data is still initial... but interesting... also there was a gender disparity... we are examining if there is a racial disparity also...

Dr. Carlsen, I disagree with you.. it is important for finding such algorithm... thyroid surgery is shifting to become an outpatient procedure... Sosa et al and others have shown that after 2009 around 60% of the thyroid procedures in the US are becoming outpatient thyroidectomies.... therefore it is important to know before had,,, before discharging the patient... if they are more likely to develop hypo Ca,,, need supplementation or not... you would know which patient needs ongoing monitoring/ discharge on meds/ and which one you can discharge without thinking twice

of note, we check calcium and PTH and vit D in the immediate postop period... 8 hours/ 12 hours/ 18 hours/ 20... for the purpose of the study. therefore, we can utilize this information before the patient is discharged (

Your findings are in god correlation with mine concerning vitamine D.Actually, what we are doing during this period is we are creating a score that can predict hypo Ca that is coming. I would be very interested in working with you (using probably both databases and writting an article). Please contact me in my private e-mail:

[email protected]

The idea is great. According to Sallinger and Moore - Am J Surg 2013 Oct 8:

“younger age and low postoperative parathyroid hormone levels are predictive of symptomatic hypocalcemia” (http://www.ncbi.nlm.nih.gov/pubmed/24112673)

Try to investigate any possible correlation of your results to the financial cost of hospital stay and the need for postoperative calcium correction (short term IV and/or long term PO).

Just to be clear, do you mean transient hypoparathyroidism or long term? We obtain a PTH level in recovery, about 30 to 60 min post op. We have found that a PTH of about 12 or less generally requires high doses of calcium and vit D analogues to avoid symptomatic hypocalcemia. A PTH over 25 portends a smooth post operative course with only minimal calcium replacement. We do not have experience with long term hypoparathyroidism in thyroidectomy patients, but in parathyroid hyperplasia it is a different matter.

I totaly agree. However, what happens when you have values between 12 and 25 (which are not unusual)? This is why I believe predicting the hypopara that is coming is very important, especially on a day surgery setting.

I can talk about two articles. In the 1st one about eight years back the study showed that in post thyroidectomy patient going  home on day care basis have to be put on Calcium supplements , which can be withdrawn once patients calcium level has become normal. This is what I am using now.

Now ,there is an article-Clinic Endocrinol(oxf)2011Mar74(3)388-93-Serum Phosphate predicts temporary hypocalcemia following thyroidectomy. We are working on these parameters right now.