Postoperative PTH measurement facilitates day 1 discharge after total thyroidectomy

OBJECTIVE: A new protocol for postoperative calcium management was developed with the aim of achieving an increase in the proportion of patients being safely discharged on the first postoperative day. We present our experience with the first 50 patients treated under this new protocol. PATIENTS AND DESIGN: A cohort study was performed involving the first 50 patients admitted for total or completion thyroidectomy, those data were then compared with a control group. Intact PTH (iPTH) was measured at 4-h postoperatively and patients with iPTH in the normal range were discharged on the first postoperative day. RESULTS: Mean age and sex distribution were similar in both groups. Mean lowest postoperative corrected calcium levels in the study group were 2.19 mmol/l and 2.15 mmol/l in the control group (P = 0.24). Parathyroid auto-transplantation was associated with low PTH levels (risk ratio = 0.49). Over 50% of patients (n = 27) were successfully discharged on the first postoperative day in the study group and no patient required readmission. Length of stay was significantly shorter in the study group, mean 1.64 vs. 2.20 days (P < 0.05). CONCLUSION: The use of iPTH accurately predicts hypocalcaemia after total thyroidectomy and can be used to facilitate safe early discharge for patients.