Hassan I, Danila R, Maurer E, Osei-Agymang T, Zielke A
Department of Visceral-, Thoracic- and Vascular Surgery, University of Giessen and Marburg, Germany.
Exp Clin Endocrinol Diabetes. 2008 Nov;116(10):614-8. doi: 10.1055/s-2008-1065333. Epub 2008 Apr 1.
The aim of this study was to compare the rate of hypocalcaemia after thyroid resection in patients with versus patients without Graves' Ophthalmopathy (GO).
153 patients following thyroid surgery for Grave's disease were studied. Patients were divided into three groups according to the severity of GO at the time of surgery using the NOSPECS classification. Subgroup I comprised of 70 patients without GO, subgroup II comprised of 63 patients with moderate GO and 20 patients with severe GO were assigned to Subgroup III. Association between severe ophthalmopathy and postoperative hypocalcaemia after thyroidectomy was investigated.
12/70 patients complained transient and 3/70 permanent hypocalcemia within subgroup I. 14/63 patients developed transient and 4/63 patients permanent hypocalcaemia within subgroup II. There were 7/20 patients with transient and 5/20 cases with permanent hypocalcaemia in the patient group with severe GO (subgroup III). The incidence of permanent postthyroidectomy hypocalcaemia was significantly higher in the subgroup III with severe GO when compared to the subgroup I without GO (p=0.004).
Although postthyroidectomy hypocalcemia seems to be a multifactorial phenomenon, this study implicates unknown role of severe GO at time of surgery in the development of hypocalcaemia after thyroid surgery for Graves' disease. Therefore, patients with GO should be considered for surgery at high volume centres specialised in thyroid and parathyroid surgery.
本研究旨在比较伴有与不伴有格雷夫斯眼病（GO）的患者甲状腺切除术后低钙血症的发生率。
对153例因格雷夫斯病接受甲状腺手术的患者进行研究。根据手术时GO的严重程度，使用NOSPECS分类将患者分为三组。第一组包括70例无GO的患者，第二组包括63例中度GO患者，20例重度GO患者被分配到第三组。研究了严重眼病与甲状腺切除术后低钙血症之间的关联。
第一组中有12/70例患者出现短暂性低钙血症，3/70例患者出现永久性低钙血症。第二组中有14/63例患者出现短暂性低钙血症，4/63例患者出现永久性低钙血症。重度GO患者组（第三组）中有7/20例患者出现短暂性低钙血症，5/20例患者出现永久性低钙血症。与无GO的第一组相比，重度GO的第三组甲状腺切除术后永久性低钙血症的发生率显著更高（p = 0.004）。
尽管甲状腺切除术后低钙血症似乎是一种多因素现象，但本研究表明，手术时严重GO在格雷夫斯病甲状腺切除术后低钙血症的发生中起未知作用。因此，对于患有GO的患者，应考虑在专门从事甲状腺和甲状旁腺手术的大容量中心进行手术。
