Abstract
Background: Three different strategies to manage transient hypocalcemia after total thyroidectomy were compared to evaluate cost-effectiveness. The reliability of total serum calcium (TSCa), ionized calcium (ICa), and intact parathyroid hormone (iPTH) were investigated to achieve this goal. Methods: A multicenter, prospective randomized study was carried out with 169 patients. The strategies were “preventive” (oral calcium + vitamin D supplementation), “reactive” (therapy in hypocalcemia), and “predictive” (therapy if iPTH <10 pg/mL). Results: TSCa had higher accuracy in identifying patients who developed hypocalcemia-related symptoms than ICa (84.6% vs 50.0%). TSCa 24 h after surgery showed 24.8% of patients with hypocalcemia, whereas TSCa 48 h after surgery identified a further 10.6% with hypocalcemia (only in the “reactive” and “predictive” groups). iPTH showed low sensitivity as a predictor of hypocalcemia. Between the 3 groups, there was no significant difference in hospitalization time or number of symptomatic hypocalcemic patients. Interestingly, the cost-per-patient was significantly different among the groups. Conclusions: None of the discussed strategies allowed for early discharge of patients without any risk of transient hypocalcemia. The “preventive” strategy was the most cost-effective, despite overtreatment.
Original language | English |
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Pages (from-to) | 3940-3947 |
Number of pages | 8 |
Journal | Head and Neck |
Volume | 41 |
Issue number | 11 |
DOIs | |
Publication status | Published - Nov 1 2019 |
Keywords
- cost
- effectiveness
- hypocalcemia
- thyroidectomy
- transient
ASJC Scopus subject areas
- Otorhinolaryngology