Inpatient and Outpatient Specialty Care Clinical Pathway for
Calcium Management in Children Undergoing Total Thyroidectomy
- Preoperative Care
- Optimize vitamin D status
- Normalize thyroid hormone levels
- Notify lab to anticipate need for ioPTH levels
- Intraoperative Care
- Place blood drawing IV
- Obtain baseline laboratory studies with induction
- Calcium, phosphorus, magnesium
- Intraoperative Sampling Times of PTH (ioPTH) Assay
- 20 minutes after induction
- After thyroid is removed
- After the central neck dissection
(if indicated/performed) - At time of closure
- Postoperative Treatment
- Begin timely calcium/calcitriol supplementation based on ioPTH levels
- Postoperative Monitoring
- Obtain calcium & phosphorus levels q 6 hrs, more frequent as clinically indicated
- Consider PTH level if symptomatic hypocalcemia or calcium < 8 mg/dL
- Monitor for Symptoms of Hypo/Hypercalcemia
ioPTH Level | Treatment | Escalation |
---|---|---|
High Risk < 10 pg/mL |
|
|
Intermediate Risk 10-20 pg/mL |
|
|
Low Risk > 20 pg/mL |
|
|
- Medications: Calcium, Calcitriol, Thyroid Hormone Therapy
- Laboratory Studies: Calcium, Phosphorous, PTH
- Appointments: Surgery, ENT, Thyroid Center
Posted: March 2019
Reviewed: April 2021
Authors: Lord, K. MD; Bauer, A. MD; Vajravelu, M. MD; Kivel, C. CRNP; Hoffman, J. MBA; Giordano, T. DNP;
Samuels, S. MD; Smith, T. CRNP; Drill, A. CRNP; Dezzi, M. CRNP; Kroeplin, G. CRNP; Durkin, M., RN; Lippold, C. RN
Reviewed: April 2021
Authors: Lord, K. MD; Bauer, A. MD; Vajravelu, M. MD; Kivel, C. CRNP; Hoffman, J. MBA; Giordano, T. DNP;
Samuels, S. MD; Smith, T. CRNP; Drill, A. CRNP; Dezzi, M. CRNP; Kroeplin, G. CRNP; Durkin, M., RN; Lippold, C. RN
Evidence
- Benefits resulting from 1- and 6-hour parathyroid hormone and calcium levels after thyroidectomy
- Hypoparathyroidism after thyroidectomy: prevention, assessment and management
- Intraoperative parathyroid hormone assay for management of patients undergoing total thyroidectomy
- Intraoperative intact parathyroid hormone level monitoring as a guide to parathyroid reimplantation after thyroidectomy
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