{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T16:57:57Z","timestamp":1773939477641,"version":"3.50.1"},"reference-count":28,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,12,26]],"date-time":"2022-12-26T00:00:00Z","timestamp":1672012800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Underreported variation in parathyroid hormone (PTH) assays exists. Using quality improvement methods, we aimed to develop an institution\u2010specific PTH\u2010based protocol to predict hypocalcemia after thyroidectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively reviewed patients who underwent total\/completion thyroidectomy. A receiver operating curve (ROC) determined postoperative PTH cut\u2010offs predictive of hypocalcemia. The stakeholders developed PTH\u2010driven calcium management guidelines. Post\u2010implementation outcomes were prospectively measured.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Pre\u2010implementation, 95 patients were assessed. PTH \u22641.5\u2009pmol\/L (14.1\u2009pg\/ml) predicted hypocalcemia (96%sensitivity), and \u22652.8\u00a0pmol\/L (26.4\u00a0pg\/ml) predicted normocalcemia (99%specificity) (area under curve\u00a0=\u00a00.97, SEM\u00a0=\u00a00.018). PTH on the day of and morning after surgery were identically predictive. Post\u2010implementation, 64 patients were assessed. Hypocalcemia occurred with PTH &gt;2.8\u00a0pmol\/L in 2 cases (3.1%). Calcium over\u2010prescribing decreased from 13.7% to 3.1% (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.06). Length of stay (LOS)\u2009&gt;\u20092 nights decreased from 13% to 3.1% (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A PTH\u2010driven calcium management protocol post\u2010thyroidectomy effectively reduces unnecessary calcium replacement and LOS. Given the variability in PTH assays, each institution may need to use individual cut\u2010offs.<\/jats:p><\/jats:sec>","DOI":"10.1002\/hed.27272","type":"journal-article","created":{"date-parts":[[2022,12,26]],"date-time":"2022-12-26T13:14:16Z","timestamp":1672060456000},"page":"595-603","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Parathyroid hormone\u2010driven algorithms after thyroid surgery: Not one\u2010size\u2010fits\u2010all"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5527-6280","authenticated-orcid":false,"given":"Shireen","family":"Samargandy","sequence":"first","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Michael Garron Hospital  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Wadie","sequence":"additional","affiliation":[{"name":"School of Medicine Royal College of 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