[Intraoperative parathyroid hormone measurement is the best predictor of postoperative symptomatic hypocalcemia]. / Die intraoperative Parathormonmessung als bester Indikator einer postoperativen symptomatischen Hypokalzämie.

BACKGROUND: The goal of this study is to evaluate risk factors for transient postoperative hypocalcemia (HC) and to define cutoff values for perioperative parathyroid hormone (PTH) and calcium parameters (Ca) to reduce the morbidity of symptomatic HC. MATERIALS AND METHODS: At our tertiary referral hospital (Luzerner Kantonsspital, Switzerland), a total of 353 patients underwent total thyroidectomy between 2006 and 2013 and were analyzed retrospectively in terms of HC risk. The serum values of calcium and PTH were measured at strictly defined time intervals, and patients' symptoms and the necessity of treatments were determined from patients' charts. RESULTS: The prevalence of transient postoperative HC was 43%; however, only 10% of patients were symptomatic. Significant risk factors for serum and symptomatic HC were calcium values (pre-, intra-, 4 h and 1 d postoperative), PTH values (intraoperative, 4 h and 1 d postoperative), and PTH decline. Interestingly, preoperative PTH values, patient age, weight of the thyroid gland, diagnosis, and sex were not significant risk factors. In the ROC analysis ('receiver operating characteristics'), calcium measurement 4 h postoperatively showed the best predictive ability for detecting serum HC, whereas intraoperative PTH measurements were predictive for symptomatic HC. CONCLUSION: Calcium and PTH values as well as PTH decline are significant risk factors for postoperative HC. Preoperatively, only calcium measurement is prognostically significant. Intraoperative PTH measurement is the most reasonable and sensitive factor for early recognition of temporary postoperative HC in the clinical setting.

Subtotal Petrosectomy and Cochlear Implant Placement in Otologic Presentation of "Wegener's Granulomatosis".

Granulomatosis with polyangitis is a rare granuloma forming necrotizing vasculitis, which involves mainly the respiratory tract and renal system. Otologic involvement may occur primarily as chronic serous otitis media and chronic silent mastoiditis with conductive hearing loss and may rarely lead to sensorineural hearing loss requiring cochlear implantation. This case describes a patient with granulomatous poylangitis with profound sensorineural hearing loss who underwent subtotal petrosectomy with cochlear implantation.