Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Ann Surg Oncol. 2011 Mar;18(3):777-81. doi: 10.1245/s10434-010-1377-5. Epub 2010 Oct 19.
Few studies have examined the need for vitamin D supplementation after total thyroidectomy. This study examines the role of postoperative day (POD) 1 serum calcium and parathyroid hormone (PTH) levels in predicting the need for long-term vitamin D supplementation after total thyroidectomy.
A retrospective, single institutional study of patients who underwent total thyroidectomy between January 2007 and December 2008 was performed. Data collected included extent of surgery, final pathology, postoperative calcium (mg/dl) and PTH (pg/ml) values, and duration of vitamin D supplementation. Patients were divided into 4 groups based on POD1 PTH values: group 1 (<5.0); group 2 (5.0-10); group 3 (10.1-20); and group 4 (>20).
Of the 104 patients, 26 were in group 1, 12 in group 2, 18 in group 3, and 48 in group 4, with median PTH values of <2.5, 8.2, 14.1, and 30 pg/ml, respectively. All 7 (7%) patients who required vitamin D supplementation >1 month were in group 1. The positive predictive value of POD1 PTH <5.0 in predicting supplementation >1 month was 27% (sensitivity 100%, specificity 80%). Seventy-eight patients had a POD1 PTH level ≥5, and none required vitamin D supplementation >1 month (100% negative predictive value). The positive predictive value of various POD1 calcium thresholds (<7.5, <8.0, and <8.5 mg/dl) was 17, 14, and 15%, respectively.
Postoperative PTH levels better predict long-term hypocalcemia requiring vitamin D supplementation than serum calcium levels. A PTH level ≥5.0 may identify patients who can be safely discharged without routine vitamin D supplementation.
很少有研究探讨全甲状腺切除术后补充维生素 D 的必要性。本研究通过检测术后第 1 天（POD）血清钙和甲状旁腺激素（PTH）水平，探讨其对全甲状腺切除术后长期补充维生素 D 的预测作用。
回顾性分析 2007 年 1 月至 2008 年 12 月期间行全甲状腺切除术的患者，收集手术范围、术后病理、血钙（mg/dl）和 PTH（pg/ml）值及维生素 D 补充时间等资料。根据 POD1 PTH 值将患者分为 4 组：组 1（<5.0）；组 2（5.0-10）；组 3（10.1-20）；组 4（>20）。
104 例患者中，组 1 26 例，组 2 12 例，组 3 18 例，组 4 48 例，PTH 值中位数分别为<2.5、8.2、14.1、30pg/ml。需要补充维生素 D>1 个月的 7 例患者均来自组 1。POD1 PTH<5.0 预测补充维生素 D>1 个月的阳性预测值为 27%（敏感度 100%，特异度 80%）。78 例患者 POD1 PTH≥5，均无需补充维生素 D>1 个月（100%阴性预测值）。不同 POD1 血钙阈值（<7.5、<8.0、<8.5mg/dl）的阳性预测值分别为 17%、14%、15%。
术后 PTH 水平比血清钙水平更能预测需要补充维生素 D 的长期低钙血症。PTH 水平≥5.0 可能有助于确定无需常规补充维生素 D 即可安全出院的患者。
