We read with interest the article by M. Richards et al.1 This study shows a high incidence of hypoparathyroidism; nevertheless, we substantially agree with the authors about the usefulness of intraoperative parathyroid hormone in predicting hypocalcemia. However, our experience suggests that it is better to use the rapid parathyroid hormone (PTH) assay on the first day after thyroidectomy, with a cutoff value of 16 pg/mL, not of 10 pg/mL.2 We studied 162 patients, and placed them in 1 of 3 groups. In 28 patients with PTH lower than 10 pg/mL, 20 developed postoperative hypocalcemia and needed replacement therapy, which was transient in 13 and permanent in 7. In 34 patients with PTH between 10 and 16 pg/mL, 14 had postoperative hypocalcemia; 9 received transient calcium and vitamin D treatment, and hypocalcemia was permanent in 2. In 100 patients with PTH higher than 16 pg/mL, 5 patients had hypocalcemia, and 1 required transient calcium and vitamin D therapy.
Toniato A, Pelizzo MR. Importance of Early Intraoperative Parathyroid Hormone Assay. Arch Surg. 2004;139(3):343. doi:10.1001/archsurg.139.3.343-a