Ian K. McLeod

Prediction of hypocalcemia after using 1- to 6-hour postoperative parathyroid hormone and calcium levels:an analysis of pooled individual patient data from 3 observational studies

Parathyroid hormone (PTH) levels up to 6 hours postthyroidectomy have been shown to have excellent predictive power in determining hypocalcemia. In this study, we investigate the usefulness of combining calcium and PTH to increase the predictive power.

Use of Parathyroid Hormone Assay after Thyroidectomy: A Survey of US and European Surgeons

Introduction Hypocalcemia after thyroidectomy results in prolongation of hospitalization and patient discomfort but can be predicted by PTH assays. However, there is considerable variation in their use. Methods This study was undertaken to document current US and European practice patterns regarding the use of this assay. Anonymous surveys were collected in 2009–2011 from members of the American Academies of Otolaryngology-Head and Neck Surgery and Endocrine Surgery and the European, Italian, French, Spanish and British Societies of Endocrine Surgery. Results There were 356 American (3% response) and 61 European (10% response) respondents. 105 (29.8%) American and 25 (41%) European respondents reported routine PTH assay use. Fellowship trained surgeons reported increased use of the PTH assay (P = 0.004). Shorter reported average post-operative hospital stay was associated with American physicians (P = 0.0001), community practice location (P = 0.0002) and routine calcium supplementation (P = 0.0015). Conclusions Surgical training was associated with routine use of the PTH assay. Average reported hospital stay was lower for American and community practice physicians and correlated with post-operative oral calcium use.

Survey of Post-thyroidectomy Parathyroid Hormone (PTH) Assay Use by American vs European Thyroid Surgeons

Objective: 1) Identify differences in PTH assay usage by European vs American physicians. 2) Analyze factors that correlate with these differences. Method: Anonymous surveys of physicians regarding their use of post-thyroidectomy PTH assay were collected in 2009 from members of the American Academies of Otolaryngology and Endocrine Surgery and compared with 2010 survey data from members of the European, Italian, French, Spanish, and British Societies of Endocrine Surgery. Results: European respondents returned 61 surveys that were compared with 356 received from American physicians (11% vs 3% response rate). A total of 40.1% of the European physicians used the PTH assay vs 29.8% of the American physicians (chi-square P = .083). A total of 63% of US respondents were otolaryngologists, compared with 7% of the Europeans, but usage among US physicians was not significantly correlated with specialty. Fewer American physicians were fellowship trained (26.6% vs 44.3% (chi-square P = .003)). Using Mann-Whitney testing, estimates of the rate of temporary hypocalcemia were similar, median 10% to 20% (P = .708), but American respondents provided a lower estimated rate of permanent hypocalcemia (P = .007). Conclusion: We found a trend suggesting that more European physicians obtain PTH levels than US physicians and report higher rates of permanent hypocalcemia among thyroidectomy patients, perhaps accounting for their more frequent use of PTH assays.

PTH Assay After Thyroidectomy A US Surgeon Survey Analysis

ysis of carotid body tumors, enlarging neck mass was not found to be significant (p 0.14). However, pain continued to be significantly different, with 67% of malignant lesions demonstrating pain, compared to only 11% of benign lesions (p 0.01). CONCLUSION: A pathologic diagnosis of malignancy is obtained when metastatic disease is identified in regional or distant lymph nodes or other distant sites. This can be problematic if radiation therapy is chosen as the primary therapy without biopsy. This study suggests that pain, a rapidly enlarging neck mass, and a younger age are significant predictive factors of underlying malignancy, which should prompt one to consider an aggressive diagnostic and management approach.

The use of rapid parathyroid hormone assay in thyroidectomy patients

Problem: Our study evaluated whether the rapid parathyroid hormone (rPTH) assay is a useful perioperative tool in predicting postoperative symptomatic hypocalcemia following total or completion thyroidectomy. Methods: We conducted a prospective study of 69 patients undergoing total or completion thyroidectomy. Rapid and intact PTH levels were obtained preoperatively, intraoperatively, and postoperatively on arrival in the postanesthesia care unit (PACU). Surgeons remained blinded to the results. All patients were closely monitored postoperatively for the development of hypocalcemia. Results: Nine patients were excluded from the study. Fifteen of 60 patients (25%) developed postthyroidectomy hypocalcemia, 7 developed laboratory (asymptomatic) hypocalcemia, and 8 developed symptomatic hypocalcemia. The onset of hypocalcemic symptoms occurred from 8 to 50 hours postoperatively (mean, 33.4 hours). In the normocalcemic group (75%), all patients except 2 had either an intraoperative or PACU rPTH greater than or equal to 12 pg/mL. Similarly, all but 5 normocalcemic patients had a 75% decline in intraoperative rPTH was 71% sensitive and 86% specific, whereas a >75% decline in PACU rPTH was 100% sensitive and 88% specific, for predicting postoperative symptomatic hypocalcemia. Conclusion: The rapid PTH assay is a highly accurate and effective tool for readily predicting postoperative symptomatic hypocalcemia immediately following thyroidectomy. Postoperative values that are obtained on arrival in the PACU appear to be more sensitive and specific than those obtained intraoperatively. Significance: Utilization of this assay is recommended, as it has the potential to safely allow the same-day discharge of normocalcemic patients and early prospective treatment of hypocalcemic patients following thyroidectomy. Support: None reported.

Revision choanal atresia repair. The final solution

that a patient is HIV seropositive often influences the decision-making process in light of their altered immune status. Otolaryngologists should have knowledge of this clinical entity. Methods: Case report and literature review of factitious HIV in an otolaryngology patient. Results: A 31-year-old woman transferred her care to our department because after becoming HIV positive she had difficulty obtaining otolaryngology care elsewhere. She was followed up in our clinic for 6 years prior to our discovery that she was HIV seronegative. During that time she was treated with multiple courses of oral antibiotics and underwent multiple surgical procedures. Conclusion: Factitious HIV is likely to become more common as the social and economic benefits available to these patients become more accessible. It is important that all otolaryngologist are aware of factitious HIV infection, the need to clearly document the presence of HIV infection before initiating care, and potential legal implications of not confirming the patients serologic status.