Department of Otolaryngology-Head and Neck Surgery, King Fahad Medical City, Riyadh, Saudi Arabia.
J Otolaryngol Head Neck Surg. 2010 Aug;39(4):342-8.
To evaluate the accuracy of measurement of different parathyroid hormone (PTH) and corrected calcium (cCa) levels at different times as early predictors of postthyroidectomy hypocalcemia.
A retrospective cohort study.
King Fahad Medical City, Riyadh, Saudi Arabia, between January 2006 and March 2009.
Patients who underwent total or completion thyroidectomy were followed until hospital discharge. Patients were observed clinically for hypocalcemia; at the same time, the postoperative PTH and cCa levels after 6, 12, and 20 hours and then twice daily were recorded.
Postthyroidectomy hypocalcemia.
Seventy-nine of 116 patients were enrolled in our study; 26.60% of them had hypocalcemia. PTH measurement at 6 hours postoperatively was an excellent predictor of hypocalcemia (area under the curve = 0.95, 95% CI 0.88-0.99). The mean PTH at 6 hours for hypocalcemic patients was 0.93 (+/- 0.60). A 1.7 pmol/L as a cutoff level of PTH at 6 hours has 95.2% sensitivity, 89.7% specificity, 76.9% positive predictive value (PPV), and 98.1% negative predictive value (NPV). On the other hand, a 2.1 mmol/L as a cutoff level of cCa has 81.0% sensitivity, 81.6% specificity, 65.3% PPV, and 90.9% NPV in predicting hypocalcemic patients.
PTH measurement 6 hours after surgery with a cutoff level of 1.7 pmol/L is more accurate than serial calcium level measurement for early prediction of patients at risk of hypocalcemia. Thus, a single PTH measurement postoperatively will help in discharging patients safely within the first 24 hours, improving bed use and cost-effective care.
评估不同时间甲状旁腺激素（PTH）和校正钙（cCa）水平的测量值作为甲状腺切除术后低钙血症的早期预测指标的准确性。
回顾性队列研究。
沙特阿拉伯利雅得法赫德国王医疗城，2006 年 1 月至 2009 年 3 月。
对接受甲状腺全切除术或甲状腺次全切除术的患者进行随访直至出院。临床观察患者低钙血症；同时记录术后 6、12、20 小时和随后每天两次的术后 PTH 和 cCa 水平。
甲状腺切除术后低钙血症。
116 例患者中有 79 例入组本研究；26.60%的患者出现低钙血症。术后 6 小时 PTH 测量是低钙血症的极好预测指标（曲线下面积=0.95，95%CI 0.88-0.99）。低钙血症患者的平均 PTH 为 0.93（+/-0.60）。6 小时 PTH 为 1.7 pmol/L 时，敏感性为 95.2%，特异性为 89.7%，阳性预测值（PPV）为 76.9%，阴性预测值（NPV）为 98.1%。另一方面，cCa 为 2.1 mmol/L 时，敏感性为 81.0%，特异性为 81.6%，PPV 为 65.3%，NPV 为 90.9%，可预测低钙血症患者。
术后 6 小时测量 PTH，以 1.7 pmol/L 为界值，比连续测量血钙水平更能准确预测低钙血症风险患者。因此，术后单次 PTH 测量有助于在 24 小时内安全出院，提高床位使用率，降低成本效益。
