全甲状腺切除术后甲状旁腺功能减退症：发生率和时间。
Parathyroid hormone deficiency after total thyroidectomy: incidence and time.
机构信息
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin 53792-7375, USA.
出版信息
J Surg Res. 2010 Sep;163(1):69-71. doi: 10.1016/j.jss.2010.03.059. Epub 2010 Apr 21.
BACKGROUND
Parathyroid hormone (PTH) deficiency or hypoparathyroidism after total thyroidectomy is not an uncommon postoperative complication. Patients who have PTH deficiency will develop profound hypocalcemia if not properly treated with oral calcium supplementation and activated vitamin D (1,25-dihydroxycholecalciferol or calcitriol). However, there is little published on the long-term outcomes of these patients. The aim of this study was to determine the incidence of PTH deficiency and the time course to resolution after total thyroidectomy.
METHODS
We identified 271 consecutive patients who underwent total thyroidectomy from January 2006 to December 2008. All patients had serum PTH levels tested 4 h after surgery and the morning after surgery. Patients were diagnosed with PTH deficiency if their serum PTH was <10 pg/mL. The outcomes of patients with PTH deficiency (group 1) were then compared with patients who did not have PTH deficiency (group 2). Patients in group 1 were evaluated for parathyroid function by measuring serum PTH levels as well as documenting usage of supplemental calcium and 1,25-dihydroxycholecalciferol.
RESULTS
Of the 271 patients, 33 (12%) were found to have PTH deficiency. In comparing PTH deficient patients (group 1) with patients in group 2, there were no differences in age, gender, thyroid pathology, the incidence of thyroiditis, or other factors that would predict hypoparathyroidism. Twenty-four patients (73%) had recovery of their PTH levels to > or =10 pg/mL at their 1 wk follow-up appointment, while 9 (27%) patients still had PTH levels <10 pg/mL. With long term follow-up, 27 (82%) patients had recovered with a PTH level of > or = 10 pg/mL, while 6 (18%) patients had a serum PTH level <10 pg/mL. However, three of the 33 patients in group 1 (9%) required long-term 1,25-dihydroxycholecalciferol, but only two of these patients had undetectable PTH levels. Thus, the overall rate of hypocalemia requiring 1,25-dihydroxycholecalciferol was <1% (two of 271 total patients).
CONCLUSIONS
We concluded that approximately 12% (33 of 271) of patients undergoing total thyroidectomy will develop PTH deficiency. Of the PTH deficient patients, 73% will return to normal parathyroid function within 1 wk of surgery. Furthermore, 82% of these PTH deficient patients will return to normal parathyroid function with long-term follow-up. Less than 1% (two of 271) of patients undergoing total thyroidectomy will require 1,25-dihydroxycholecalciferol for long-term hypocalcemia.
背景
甲状旁腺激素（PTH）缺乏或甲状腺全切除术后甲状旁腺功能减退症并非罕见的术后并发症。如果未通过口服钙剂和活性维生素 D（1,25-二羟胆钙化醇或骨化三醇）适当治疗，PTH 缺乏的患者将发生严重低钙血症。然而，关于这些患者的长期结果，发表的内容很少。本研究旨在确定甲状腺全切除术后 PTH 缺乏的发生率和恢复时间。
方法
我们确定了 2006 年 1 月至 2008 年 12 月期间连续 271 例接受甲状腺全切除术的患者。所有患者在手术后 4 小时和手术后次日早上均检测血清 PTH 水平。如果患者的血清 PTH<10pg/mL，则诊断为 PTH 缺乏症。然后，将 PTH 缺乏症患者（第 1 组）的结果与未患有 PTH 缺乏症的患者（第 2 组）进行比较。第 1 组患者通过测量血清 PTH 水平以及记录补充钙和 1,25-二羟胆钙化醇的使用情况，来评估甲状旁腺功能。
结果
在 271 例患者中，有 33 例（12%）被发现患有 PTH 缺乏症。在比较 PTH 缺乏症患者（第 1 组）和第 2 组患者时，年龄、性别、甲状腺病理学、甲状腺炎发生率或其他预测甲状旁腺功能减退症的因素均无差异。24 例（73%）患者在 1 周随访时 PTH 水平恢复至≥10pg/mL，而 9 例（27%）患者的 PTH 水平仍<10pg/mL。经过长期随访，27 例（82%）患者的 PTH 水平恢复至≥10pg/mL，而 6 例（18%）患者的 PTH 水平仍<10pg/mL。但是，第 1 组的 33 例患者中有 3 例（9%）需要长期使用 1,25-二羟胆钙化醇，但其中只有 2 例患者的 PTH 水平无法检测到。因此，需要 1,25-二羟胆钙化醇治疗低钙血症的总发生率<1%（271 例患者中 2 例）。
结论
我们得出结论，约 12%（33 例）接受甲状腺全切除术的患者将发生 PTH 缺乏症。在 PTH 缺乏症患者中，73%的患者将在手术后 1 周内恢复正常甲状旁腺功能。此外，这些 PTH 缺乏症患者中的 82%将随着长期随访恢复正常甲状旁腺功能。接受甲状腺全切除术的患者中，不到 1%（271 例患者中有 2 例）需要长期使用 1,25-二羟胆钙化醇治疗低钙血症。
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