Thyroidectomy Perioperative Management

Pathway Background and Objectives

Hypocalcemia secondary to hypoparathyroidism is the most common post-operative complication following thyroid surgery. Biochemical hypoparathyroidism is defined as an inappropriately low intact PTH relative to the serum calcium. Hypocalcemia lags behind hypoparathyroidism by hours. Early testing of PTH can help identify patients at risk of hypocalcemia. Utilizing a clinical pathway enables clinicians to improve calcium management in thyroidectomy patients, avoid severe hypocalcemia, decrease use of IV calcium and avoid unnecessary testing and treatment, which could potentially increase cost savings. The specific objectives of this clinical pathway are to:

  • Provide a standardized approach for calcium management of patients undergoing thyroidectomy
  • Improve patient outcomes by early identification and treatment of patients at risk for hypocalcemia due transient or permanent hypoparathyroidism and/or background vitamin D deficiency
  • Minimize the amount of unnecessary laboratory testing, medication use and length of hospitalization, therefore decreasing medical costs

Algorithm  Educational Module

  • Percentage of patients with pathway order set usage

  • Percentage of patients who have Endocrine involvement prior to surgery

  • Percentage of patients who have Endocrine involvement post-surgery

  • Percentage of patients with pre-operative labs drawn per pathway

  • Percentage of patients with post-operative serum calcium level ≥ 8.5

  • Percentage of patients with post-operative serum calcium level < 8.5 post who receive IV calcium

  • Percentage of patients with PTH ≥ 15 who have serum calcium obtained 4-6 hours post-surgery

  • Percentage of patients with PTH < 15 who have serum calcium obtained within 60 minutes post-surgery

  • Total number of calcium and phosphorus lab checks per patient

  • Percentage of patients who require IV calcium treatment

  • Percentage of patients admitted to the PICU

  • Length of stay (days)

  • Readmission within 14 days

  • Returns to ED within 14 days

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.