Journal of Postgraduate Medicine
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Year : 2013  |  Volume : 59  |  Issue : 4  |  Page : 344-345  

Authors' reply

PV Pradeep1, K Ramalingam2, B Jayashree2,  
1 Department of Endocrine Surgery, Narayana Medical College and Superspeciality Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
2 Department of Biochemistry, Narayana Medical College and Superspeciality Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India

Correspondence Address:
P V Pradeep
Department of Endocrine Surgery, Narayana Medical College and Superspeciality Hospital, Chinthareddypalem, Nellore, Andhra Pradesh

How to cite this article:
Pradeep P V, Ramalingam K, Jayashree B. Authors' reply.J Postgrad Med 2013;59:344-345

How to cite this URL:
Pradeep P V, Ramalingam K, Jayashree B. Authors' reply. J Postgrad Med [serial online] 2013 [cited 2022 Nov 27 ];59:344-345
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We read the comments on our article published earlier. [1],[2] From a clinical perspective, there are multiple factors that can lead to post total thyroidectomy (TT) hypocalcemia. Out of these, we included eight factors that are most important in causing hypocalcemia. We have highlighted each of these points and stated the relevance of these factors based on literature. We think that it is enough to say that these factors are important as predictors. However, as practicing thyroidologists, we also understand that in each patient, any one of these factors may play a more important role than the other. For example, in a hyperthyroid patient, the vitamin D level may or may not play a role. In some patients, multiple factors may play a role. So, we have given equal importance to each of these factors and assigned the score instead of weighting. Otherwise, we would have to design a separate scoring system for each and every single patient which is not practical.

The cut-off points of these factors exist in literature. These give the methodology of how these cut-offs have been derived. Many endocrine centers around the globe are now using these cut-off values. [3] The clinicians who are using these individual cut-offs are satisfied with the results and the clinical management is based on these cut-offs. Hence, we did not feel that separate cut-off points had to be calculated in this study.

We would also like to point out that multiple logistic regression (MLR) was used to find which among the eight factors in our patient was the most dependable for prediction. Regarding the ratio of events per predictor, we have already acknowledged a small sample size. The surgeries in this series have been performed by an expert endocrine surgeon, and having events per predictor of more than 10 will need many hundreds of thyroidectomies. Wehave suggested a multicentric study which will be limited by surgeons operating with different technical expertise levels.

Looking at the literature, we realize that no attempt has been made to use multiple factors and put forward a possible scoring system. We have also the need for validation. In medical literature, application of pure statistics alone may not be appropriate. The clinical course and predictions of an individual patient can go e beyond mathematical calculations, and physicians and surgeons who treat patients on a day to day basis will be the most appropriate people to judge these results. The scoring system we hope will be a useful adjunct.


The authors would like to acknowledge Sidharth Muralidharan PhD, School of Mass Communication and Journalism, The University of Southern Mississippi, USA for his valuable contributions in the statistical analysis of the data. This paper was presented as a poster at the 81 st Annual meeting of the American Thyroid Association at Indian Wells, California held during October 26-30, 2011. The paper presentation was supported by the Indian Council of Medical Research grant no. 3/2/TG-21/HRD-2011.


1Pradeep PV, Ramalingam K, Jayasree B. Post total thyroidectomy hypocalcemia: A novel multi-factorial scoring system to enable its prediction to facilitate an early discharge. J Postgrad Med 2013;59:4-8.
2Kumar R. Methodological aspects in the use of scoring and multivariable logistic regression as predictive model. J Postgrad Med 2013;59:343-4.
3Noordzij JP, Lee SL, Bernet VJ, Payne RJ, Cohen SM, McLeod IK, et al. Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: An analysis of pooled individual data from nine observational studies. J Am Coll Surg 2007;205:748-54.

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