P95 - ECE_1772 - Optimizing post-thyroidectomy care through a PTH and calcium–guided algorithm

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Abstract Introduction Thyroidectomy is a fundamental therapeutic intervention in the management of a broad spectrum of both benign and malignant thyroid disorders. However, it entails significant risks, including iatrogenic hypoparathyroidism, the most frequent complication associated with bilateral thyroid surgery.1 Since 2019, our institution has implemented a standardized post-thyroidectomy protocol using parathyroid hormone (PTH) and calcium measurements to stratify hypocalcemia risk and guide calcium and alfacalcidol supplementation. Objective This study aimed to assess the effectiveness of this structured approach in reducing the incidence of unscheduled referrals due to hypocalcemia within three weeks after total thyroidectomy and evaluate the utility of early postoperative PTH levels in predicting the development of permanent hypoparathyroidism (PhP). Methods A retrospective observational cohort study was conducted at Radboud University Medical Center Nijmegen, including 373 adult patients who underwent total/ completion thyroidectomy between January 2014 and April 2025. Patients were assigned to either the post-protocol cohort (PPC) (n = 154) or the historic cohort (n = 219), depending on whether surgery occurred after or before protocol implementation, and subsequently compared. Results Unscheduled referrals were significantly more frequent in the historic cohort than in the PPC (19.2% vs 11% respectively, P = .034), and the introduction of the protocol was associated with a significant reduction in the odds of these referrals. Early postoperative PTH levels were a significant predictor of unscheduled referrals (P = .003), postoperative hypocalcemia (P < .001) and PhP (P < .001). A postoperative PTH cutoff of 1.7 pmol/L was identified as a clinically meaningful threshold for PhP prediction, demonstrating 100% sensitivity. Conclusions Subject to assay availability and workflow efficiency, these findings support the widespread implementation of this standardized protocol to mitigate post-thyroidectomy emergency consultations and readmissions.

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