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Biomedicines
Volume 14
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10.3390/biomedicines14010062
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Article

Predicting Hypocalcemia and Identifying Supplementation Needs After Total Thyroidectomy: The Role of Perioperative PTH Measurements

by
Angeliki Emmanouilidou
1,2,*,
Athina Stamati
1,
Eleni Avramidou
1,
Philippos Tasioudis
1,
Eleni Tziona
1,
Charilaos Koulouris
2,
Michael Karanikas
2,
Kalliopi Pazaitou-Panayiotou
3 and
Nickos Michalopoulos
2
1
School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
2
Department of Endocrine Surgery, Genesis Hospital, 55535 Thessaloniki, Greece
3
European Interbalkan Medical Center, 57001 Thessaloniki, Greece
*
Author to whom correspondence should be addressed.
Biomedicines 2026, 14(1), 62; https://doi.org/10.3390/biomedicines14010062 (registering DOI)
Submission received: 30 November 2025 / Revised: 22 December 2025 / Accepted: 24 December 2025 / Published: 26 December 2025
(This article belongs to the Section Molecular and Translational Medicine)
Versions Notes

Abstract

Background: Post-thyroidectomy hypocalcemia is a common complication, yet the optimal perioperative markers for identifying high-risk patients and guiding supplementation remain debated. This study aimed to evaluate factors associated with hypocalcemia at 24 h after total thyroidectomy, identify independent predictors, and assess the reliability of early PTH measurement in determining supplementation needs. Methods: We conducted a single-center prospective cohort study including 200 patients undergoing total thyroidectomy at Genesis Hospital, Thessaloniki, between November 2022 and March 2025. PTH was measured preoperatively, 10 min post-resection, and at 24 and 72 h; calcium and phosphorus were measured preoperatively and postoperatively. Results: Independent predictors of hypocalcemia at 24 h were female sex, preoperative calcium, and PTH at 10 min. Age, pathology, incidental parathyroid excision, and extent of surgery were not significantly associated with hypocalcemia. ROC analysis showed that a preoperative calcium cutoff of 9.47 mg/dL yielded an AUC of 0.73, with 70.1% sensitivity and an NPV of 82%. PTH at 10 min with a cutoff of 24.6 pg/mL yielded an AUC of 0.66, with 70.1% sensitivity and an NPV of 79%. For supplementation needs, PTH at 10 min demonstrated excellent discrimination, with a cutoff of 16.3 pg/mL at 24 h and 14.1 pg/mL at 72 h. Conclusions: Preoperative calcium and PTH measured 10 min after thyroid removal are useful markers for predicting hypocalcemia after total thyroidectomy, with early PTH also accurately identifying supplementation needs.
Keywords: hypocalcemia; total thyroidectomy; PTH; supplementation; calcium hypocalcemia; total thyroidectomy; PTH; supplementation; calcium

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MDPI and ACS Style

Emmanouilidou, A.; Stamati, A.; Avramidou, E.; Tasioudis, P.; Tziona, E.; Koulouris, C.; Karanikas, M.; Pazaitou-Panayiotou, K.; Michalopoulos, N. Predicting Hypocalcemia and Identifying Supplementation Needs After Total Thyroidectomy: The Role of Perioperative PTH Measurements. Biomedicines 2026, 14, 62. https://doi.org/10.3390/biomedicines14010062

AMA Style

Emmanouilidou A, Stamati A, Avramidou E, Tasioudis P, Tziona E, Koulouris C, Karanikas M, Pazaitou-Panayiotou K, Michalopoulos N. Predicting Hypocalcemia and Identifying Supplementation Needs After Total Thyroidectomy: The Role of Perioperative PTH Measurements. Biomedicines. 2026; 14(1):62. https://doi.org/10.3390/biomedicines14010062

Chicago/Turabian Style

Emmanouilidou, Angeliki, Athina Stamati, Eleni Avramidou, Philippos Tasioudis, Eleni Tziona, Charilaos Koulouris, Michael Karanikas, Kalliopi Pazaitou-Panayiotou, and Nickos Michalopoulos. 2026. "Predicting Hypocalcemia and Identifying Supplementation Needs After Total Thyroidectomy: The Role of Perioperative PTH Measurements" Biomedicines 14, no. 1: 62. https://doi.org/10.3390/biomedicines14010062

APA Style

Emmanouilidou, A., Stamati, A., Avramidou, E., Tasioudis, P., Tziona, E., Koulouris, C., Karanikas, M., Pazaitou-Panayiotou, K., & Michalopoulos, N. (2026). Predicting Hypocalcemia and Identifying Supplementation Needs After Total Thyroidectomy: The Role of Perioperative PTH Measurements. Biomedicines, 14(1), 62. https://doi.org/10.3390/biomedicines14010062

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