Monitoring

The frequency of postoperative monitoring of patients after thyroid or parathyroid surgery will depend on several factors:

  • Extent of the surgery (e.g., removal of single adenoma, uncomplicated lobectomy, or total thyroidectomy with lymph node dissection carry different risks)

  • Intraoperative parathyroid hormone (PTH) levels at the end of thyroid surgery (after total thyroidectomy)

  • Levels of serum calcium within several hours of surgery

  • Presence and severity of symptoms of hypocalcaemia, if any, after surgery.

If the patient stays overnight, serum calcium levels should be checked at least twice during the first 24 hours, with the last measurement done the morning after surgery. If these serum calcium levels are normal or just mildly and transiently reduced, then the patient may be discharged with calcium supplements to be taken as needed.

If the patient has required intravenous calcium or has been symptomatic, then additional inpatient or outpatient monitoring may be warranted, depending on the circumstances. Calcitriol may be prescribed for outpatient use along with calcium supplements.

Two weeks post-surgery, the patient is seen in the outpatient clinic, and serum calcium and albumin and plasma PTH levels are repeated. If the patient has normal lab tests and is clinically stable, then calcium and calcitriol (if used) are discontinued. If serum calcium is instead reduced at this visit, then further monitoring with intact plasma PTH levels is recommended and longer treatment given. Patients with low plasma PTH and low serum calcium levels will take longer to recover.

Chronic hypoparathyroidism

Monitoring for patients with chronic hypoparathyroidism on stable doses of calcium and calcitriol can be done safely every 6-12 months with:[1]

  • repeat laboratory profile (calcium adjusted for albumin or ionised calcium and serum magnesium, phosphorus, creatinine, and 25-hydroxyvitamin D)

  • 24-hour urine for creatinine and calcium.

More frequent monitoring is required with dose changes in medications. Unstable patients are followed more closely to ensure that serum calcium does not fluctuate widely and to avoid the symptoms and the long-term complications of hypoparathyroidism.[1]

Patients are instructed to contact their physician immediately should any symptoms (paraesthesias, muscle cramping) develop. If the symptoms are mild in a patient already taking calcium with or without calcitriol, the calcium dose may be doubled, and lab tests obtained in 2 or 3 days. If the symptoms are moderate or severe, lab tests should be obtained promptly to confirm the severity and advise treatment accordingly.

Evaluation for the presence of nephrocalcinosis or nephrolithiasis can be performed by ultrasound or computed tomography of the kidneys. Refer patients who are experiencing visual symptoms for slit-lamp examination searching for ocular complications.[1]

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