A Postanesthesia Care Unit Parathyroid Hormone-Based Protocol for Managing Postthyroidectomy Hypocalcemia

Introduction: Hypocalcemia occurs in 20%-40% of total thyroidectomy cases, traditionally requires 1-2 ds of hospitalization for management. This study examines the extent of hypocalcemia following a postanesthesia care unit (PACU) parathyroid hormone (PTH)-based protocol after outpatient thyroidectomy.

Methods: Patients who underwent total or completion thyroidectomy for non-Graves' disease at a single institution between December 2015 and September 2023 were included. Postoperative calcium and calcitriol supplementation followed a standardized protocol based on PACU PTH levels (<2, 2-9, 10-19, or >20 pg/mL), with higher doses given to patients with lower PACU PTH levels. Clinical outcomes including hypocalcemia were assessed.

Results: Of the 250 patients included, the majority were female (77%) and White (69%), with a mean age of 47 ± 19 ys. The percentages of patients in the <2, 2-9, 10-19, and >20 PACU PTH groups were 4.4%, 20.0%, 20.8%, and 54.8%, respectively. A total of 61 (24.4%) patients experienced symptomatic hypocalcemia, with the highest incidence (81.8%) in the <2 group and the lowest (5.1%) in the >20 group. By 2 wks postsurgery, 6% had low serum calcium (<8.4 mg/dL), and 3.6% had persistent hypocalcemia symptoms. All patients resolved their symptoms at the last follow-up. There were 17 (6.8%) phone consultations and 3 (1.2%) emergency department visits due to hypocalcemia concerns. The readmission rate was 3.6%, with hypocalcemia causing only one case (0.4%).

Conclusions: Using our PACU PTH protocol for outpatient total thyroidectomy is associated with a relatively low incidence of hypocalcemia requiring emergency department visits or readmission.