Thyroid Surgery - Post Op

Question 1

Total Thyroidectomy - Post Op Care

Answer 1

I. Parathyroid Monitoring

A. Draw an intact PTH level immediately upon arrival to the RR

1. If PTH > 14pg/mL, Give Ca only
2. If PTH is 10 - 14pg/mL, Give Calcitriol 0.25mcg po QD + 1 gram elemental Ca BID x one week
3. If PTH < 10pg/mL, give 0.25mcg Calcitriol BID + 2 grams elemental CA TID. Repeat PTH, Ca, Mg, Phos prior to discharge. If normal, no further testing.
4. For patient > 70kg or patients with PTH < 1pg/mL, give 0.5mcg Calcitriol po BID + Ca

B. Miscellaneous

1. First post op visit at one week. Check path, wound, and PTH and Ca levels for patients with PTH < 10pg/mL
2. Place patient on Cytomel 25mcg po BID until final path is available.

Question 2

Forteo use in post op hypocalcemia

Answer 2

1. This is recombinant Parathyroid hormone
2. If Calcitriol and Calcium don’t work, give 20mcg SQ BID X one week, then 20mcg SQ QD X one week, then check PTH level.
3. Note:

• The patient must be off of Forteo for 72 hours before you check the final PTH level
• Forteo = teriparatide (a PTH analog)
• Comes as a 20 mcg/dose subcutaneous pen injector

Question 3

Parathyroid Hormone Monitoring/Treatment Following Total or Completion Thyroidectomy

Answer 3

Obtain an intact PTH level immediately upon arrival in the Recovery Room

• For a PTH > 14 pg/mL - give Calcium supplementation only
• For PTH of 10-14 pg/mL - give 0.25 mcg of Calcitriol po QD + 1 gram of elemental Calcium BID for first week only
• For a PTH < 10 pg/mL - give 0.25 mcg of Calcitriol po BID + 2 grams of elemental Calcium TID (Note: patient’s > 70 kg or with a PTH level < 1 pg/mL should be replaced with 0.5 mcg of Calcitriol BID)
• For patients with a PTH level < 10 pg/mL, a repeat PTH and serum calcium, magnesium, and phosphorus levels are obtained prior to discharge. If normalized, no further testing is required

Question 4

David Terris Post Total Thyroidectomy Calcium Regimen

Answer 4

Give OsCal Taper over 3 weeks post op - begin the evening of surgery

• Take 1000 mg OsCal + Vitamin D po TID X 7 days
• Then, take 1000 mg OsCal + Vit D BID X 7 days
• Then, take 1000 mg Oscal + Vit D QD X 7 days
• Take 1000 mg OsCal + Vit D every 30 minutes if the patient develops perioral or hand numbness/tingling. Notify the doctor if this doesn’t relieve symptoms.
• Note: using this regimen, Dr. Terris does total/completion thyroidectomy as an outpatient procedure. Dr. Terris does not measure PTH level at all post op

Question 5

What is the incidence of wound hematoma following thyroid surgery?

Answer 5

0.55%

Question 6

What is the risk factor for post op hematoma in thyroid surgery?

Answer 6

1) Preinduction blood pressure greater than 160mm of Mercury
2) Patients with poorly controlled hypertension may not be good candidates for outpatient thyroid surgery