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Background: Postoperative hypocalcemia (PoHC) is the most common complication of total thyroidectomy (TT). The availability of a reliable predictor of PoHC would allow early calcium supplementation, avoiding hypocalcemia, and potentially decreasing hospital stay. Objective: To determine the value of a single rapid intraoperative PTH (iPTH) level and influence of patient demographics, thyroid pathology, and lymph node resection in predicting PoHC after TT. Study design: A single-institution prospective observational study. Subjects and methods: Ninety-eight patients underwent a total or completion TT over one year. PTH was measured intraoperatively 15 minutes after completion of the TT. Hypocalcemia was defined as corrected calcium levels of ≤ 7.5 mg/dL or symptomatic hypocalcemia. ROC-AUC and logist regression analysis of iPTH, age, and BMI was conducted. Results: Compared to normocalcemic patients (n = 76), hypocalcemic patients (n = 22) were younger (44.8 ± 3.1 vs. 63.2 ± 1.6 years; p < 0.0001), had lower BMI (25.4 ± 0.9 vs. 29.1 ± 0.6 kg/sqm; P = 0.0045) and lower iPTH levels (15.5 ± 2.4 vs. 61.7 ± 7.3 pg/ml; P = 0.0033). Serum calcium levels were directly associated with younger age (P = 0.0004), lower BMI (P = 0.0003), and lower iPTH levels (P = 0.0004). IPTH levels lower than 16.75 pg/ml (ROC-AUC: 0.825; 95% CI 0.74-0.93; p < 0.0001) identified hypocalcemia with a sensitivity of 77% and a specificity of 75%. Levels of iPTH ≥ 36.25 pg/ml predicted normocalcemia with a sensitivity of 95.5% and a PPV 97.8. The combination of iPTH, age, and BMI further improved the risk prediction of PoHC (mean ROC-AUC 0.95; 95% CI: 0.91-0.99). A combination of iPTH > 12.5 pg/ml, > 31 years of age, and a BMI > 22.5 kg/m2 predicted a normocalcemic course with a sensitivity of 100%. Lymph node dissection, histologic diagnosis, indication for surgery, and intraoperative complications were not associated with serum calcium, age, BMI, or iPTH levels. Conclusion: A single low iPTH is strongly and significantly associated with PoHC in post-thyroidectomy patients. Age and BMI also independently predicted risk of PoHC. Younger age and lower BMI increased risk of PoHC and increased the predictive power of iPTH.

Predictors of Postoperative Hypocalcemia after Total Thyroidectomy: The Role of a Single Intraoperative Rapid PTH