iPTH levels may develop postoperative hypocalcemia . Similarly, the Australian Endocrine Surgeons Guidelines Group reported a false-negative results rate of 7% . Despite epigallocatechin hypocalcemia in patients with normal iPTH levels is usually mild and self-limiting , this occurrence is of some concern. For this reason management protocols based on postoperative iPTH levels usually include serial inpatient calcium level measurements or prophylactic OC administration to all the patients in order to allow a safe early discharge , even in the presence of postoperative iPTH within the normal range.
Further studies demonstrated that combining early postoperative iPTH and serum AP23573 calcium levels could result in better predictability of the risk of postoperative hypocalcemia . Obviously, such findings could be related, at least in part, to the fact that the pathogenesis of post-thyroidectomy hypocalcemia is variable and possibly multifactorial, even if impaired parathyroid function is the most important factor . Based on the latter findings, we developed a selective supplementation treatment protocol for patients who underwent bilateral thyroid resection that is based on both early postoperative iPTH and serum calcium levels, differentiating among patients who receive OC and VD from those who receive OC alone and those who are discharged without any purchase phenformin supplementation treatment .
The aim of this study was to evaluate the efficacy of this treatment protocol to prevent post-thyroidectomy hypocalcemia and related symptoms, thus avoiding the need for routine supplementation. Materials and methods All the patients who underwent total or completion thyroidectomy between July and October 0 were included in this study. Exclusion criteria included concomitant parathyroid disease and renal failure. Surgical procedure All the surgical procedures were performed by an experienced endocrine order norxacin surgeon or by a resident operating under supervision at the Division of General and Endocrine Surgery of the Policlinico A.
Gemelli, Universita Cattolica del Sacro Cuore, Rome, Italy. Patients undergoing both conventional thyroidectomy and videoassisted thyroidectomy were included in the study. Surgical techniques for both CT and VAT have been described elsewhere . Total thyroidectomy is defined as total bilateral extracapsular thyroidectomy; completion thyroidectomy is defined as the removal of all residual thyroid tissue after previous unilateral or bilateral thyroid resections . In all the cases, an effort was made by the surgeons to identify and preserve all the parathyroid glands. Parathyroid ribosome autotransplantation in the homolateral sternocleidomastoid muscle was performed only in cases of compromise of vascular supply or inadvertent excision. Patients who underwent concomitant central neck dissection or central neck dissection plus lateral neck dissection were included as well. Study protocol iPTH was measured preoperatively and 4 h after the end of the operation by an .