P33: PROPOSAL OF A NEW SCORING TOOL FOR PREDICTION OF HYPOCALCEMIA IN PATIENTS UNDERGOING SURGERY FOR PAPILLARY THYROID CANCER

Introduction

Post-operative hypocalcemia occurs more frequently in certain high-risk patients. The aim of our study is to propose a preliminary scoring system to identify patients who are more likely to develop hypocalcemia following surgery for papillary thyroid cancer.

Method

The study was performed with a retrospective developmental cohort(n=131) and a prospective validation cohort(n=71). Patients underwent either Total Thyroidectomy(TT), TT+Central Neck Dissection(CND) or TT+CND+Modified Radical Neck Dissection(MRND). Significant pre-operative variables and operative findings were converted into categorical variables for analysis. Univariate, multivariate analysis and a logistic regression were used to select significant predictors. The score was constructed by converting into integer, the regression coefficients of independently predictive factors in the logistic regression model. This score was validated prospectively in the validation cohort.

Result

24(18%) out of 131 patients in the developmental cohort and 16(22.5%) out of 71 patients in the validation cohort had symptomatic hypocalcemia. Thyroiditis, positive lymph node metastasis, central and lateral compartment dissection, Neutrophil-to-lymphocyte ratio(NLR)>3.35 and platelet-to-lymphocyte ratio(PLR)>135 were selected as significant predictors. A score with a range of 0-11 was created. The cut-off value for the score was 6 points(sensitivity of 92.0% and specificity of 89.0%). Areas under the ROC curve for the scores were 0.926 and 0.901 in the developmental and validation cohorts, respectively.

Conclusion

This score could be a tool in the prediction of hypocalcemia and could help in identifying patients at a higher risk of post-operative hypocalcemia and guide calcium/Vitamin D treatment, as well as facilitate a safe earlier hospital discharge for low risk patients.

Take-home message

The proposed scoring system could help in identification of patients at a higher risk of post-operative hypocalcemia.

P32: POST-OPERATIVE RELATIVE PARATHORMONE DECLINE (ΔPTH%) AND ABSOLUTE PARATHORMONE DECLINE (ΔPTH) LEVELS ARE BETTER MARKERS OF SYMPTOMATIC HYPOCALCEMIA FOLLOWING TOTAL THYROIDECTOMY THAN POST-OPERATIVE PTH ALONE

Introduction

Hypocalcemia is a frequent complication following thyroidectomy which can delay discharge and increase overall treatment expenditure. We aimed to assess the predictive value of absolute and relative intact Parathormone(iPTH) decline levels as reliable markers of post-operative hypocalcemia.

Method

This prospective study included 95 consecutive patients at our tertiary care centre. Patients underwent either Total Thyroidectomy(TT), TT+Central Neck Dissection(CND) or TT+CND+Modified Radical Neck Dissection(MRND). iPTH levels were measured four hours after surgery and the following morning after surgery(POD 1). iPTH, absolute iPTH decline(ΔPTH) and relative iPTH decline(ΔPTH%) were calculated and correlated with hypocalcemia. Comparisons between groups were measured by chi-square test, Fischer's exact test and Mann-Whitney U test.

Result

Of the 95 patients, 59 had malignant disease, while 36 patients had benign histopathology. TT was performed in 69 patients, TT+CCLND in 7, and TT+CCLND+MRND in 19. 32.6% of patients(n=31) had biochemical hypocalcemia and 20%(n=19) had symptomatic hypocalcemia. The mean calcium of the cohort on Post-operative day(POD)-1 was 8.3±0.66(range=6.5-9.9) and POD-3 was 8.4±0.69(range=6.3–10.7). Median PTH, measured 4 hours after surgery was 24pg/ml(IQR–23.4;range 2.5–85.5), and measured on POD-1 was 28pg/ml(IQR–27.6;range=2-79). The ΔPTH(U=206;p<0.001) & ΔPTH% (U=127;p<0.001) were significantly higher in patients with symptomatic hypocalcemia. A ΔPTH% of 20%(sensitivity=84%;specificity=91%) and ΔPTH of 3.75 pg/ml(sensitivity = 74%; specificity=87%) were good predictors of symptomatic hypocalcemia.

Conclusion

Post-operative ΔPTH and ΔPTH% are reliable predictors of hypocalcemia following thyroid surgery and have the potential to facilitate a safe early discharge for patients undergoing TT. 20% fall in the PTH level(ΔPTH%) can be useful as a marker of hypocalcemia.

Take-home message

Post-operative ΔPTH and ΔPTH% are better predictors of hypocalcemia following thyroid surgery than a single value of post-operative PTH alone.

Parathormone decline levels are better markers of symptomatic hypocalcemia following total thyroidectomy than parathormone alone

Background: We aimed to assess the predictive value of the absolute and relative intact parathormone (iPTH) decline levels as reliable markers of postoperative hypocalcemia. Materials & methods: iPTH levels were measured 4 h after surgery and the following morning after surgery (postoperative day 1). iPTH, absolute iPTH decline (ΔPTH) and relative iPTH decline (ΔPTH%) were calculated and correlated with symptomatic hypocalcemia. Results: Of the 95 patients, 20% of patients (n = 19) developed symptomatic hypocalcemia. The ΔPTH (U = 206; p < 0.001) and ΔPTH% (U = 127; p < 0.001) were significantly higher in patients with symptomatic hypocalcemia. A ΔPTH% of 20% (sensitivity of 84%; specificity of 91%); and an absolute iPTH decline of 3.75 pg/ml (sensitivity of 74%; specificity of 87%) were highly predictive of symptomatic hypocalcemia. Conclusion: Postoperative ΔPTH and ΔPTH% have the potential to be predictors of symptomatic hypocalcemia following thyroidectomy and could facilitate a safe early discharge.

Liver atrophy associated with monolobar Caroli's disease

The association of the atrophy-hypertrophy complex in monolobar Caroli's disease (Type I) is reported in a 30 year old male who presented with recurrent cholangitis. Ultrasound and CT scan showed localised, right sided, saccular biliary dilatation in a normal sized liver. Severe right lobar atrophy was detected at operation and the resected right lobe weighed only 140 gms. Distortion of the hilar vascular anatomy and posterior displacement of the right hepatic duct orifice were problems encountered at surgery.