Del Río Laura, Castro Alejandro, Bernáldez Ricardo, Del Palacio Antonio, Giráldez Carolina V, Lecumberri Beatriz, Alvarez-Escolá Cristina, Fernández-Martínez Alberto
Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, España.
Acta Otorrinolaringol Esp. 2011 Jul-Aug;62(4):265-73. doi: 10.1016/j.otorri.2011.01.007. Epub 2011 Apr 14.
The risk of developing hypocalcemia is the reason for prolonged hospitalisation after total thyroidectomy. The objective of this study was to validate parathyroid hormone measurement for predicting post-thyroidectomy hypocalcemia.
Eighty-two patients who underwent total or completion thyroidectomy from February 2009 to March 2010 were enrolled in this prospective study to determine the best timing and cutoff point of parathyroid hormone to predict hypocalcemia. Patients with any condition that could interfere with calcium homeostasis were excluded from the survey. Parathyroid hormone and serum calcium levels were determined preoperatively, immediately after surgery and a number of hours later.
Treatment for hypocalcemia was required in 16.7% of patients. A percent of delayed decrease in parathyroid hormone was chosen as the best measurement to predict hypocalcemia. An 80% or higher decrease in delayed parathyroid hormone levels had 100% sensitivity (95% CI: 77.2-100%) and 87% specificity (95% CI: 77-93%) for selecting patients for early discharge. Using this test, 73.2% of the patients could have been discharged 24 hours after surgery. A 98% decrease in delayed parathyroid hormone levels could select candidates for early calcium replacement with 98.6% specificity (95% CI: 92.2-99.7%).
The decrease in postoperative delayed parathyroid hormone levels is a good predictor of post-thyroidectomy hypocalcemia. A decrease of 80% or more in delayed parathyroid hormone level is a test with excellent sensibility and specificity for selecting candidates for early discharge. The 98% cutoff point has high specificity for selecting patients for early calcium replacement.
发生低钙血症的风险是全甲状腺切除术后住院时间延长的原因。本研究的目的是验证甲状旁腺激素测量对预测甲状腺切除术后低钙血症的作用。
本前瞻性研究纳入了2009年2月至2010年3月接受全甲状腺切除术或甲状腺次全切除术的82例患者，以确定甲状旁腺激素预测低钙血症的最佳时间点和临界值。将任何可能干扰钙稳态的患者排除在研究之外。在术前、术后即刻及术后数小时测定甲状旁腺激素和血清钙水平。
16.7%的患者需要进行低钙血症治疗。甲状旁腺激素延迟下降百分比被选为预测低钙血症的最佳指标。甲状旁腺激素延迟水平下降80%或更高，对于选择早期出院患者的敏感性为100%（95%CI：77.2-100%），特异性为87%（95%CI：77-93%）。使用该检测方法，73.2%的患者术后24小时即可出院。甲状旁腺激素延迟水平下降98%可筛选出早期补钙的患者，特异性为98.6%（95%CI：92.2-99.7%）。
术后甲状旁腺激素延迟水平下降是甲状腺切除术后低钙血症的良好预测指标。甲状旁腺激素延迟水平下降80%或更多，是一种筛选早期出院患者的敏感性和特异性均极佳的检测方法。98%的临界值对于筛选早期补钙患者具有高特异性。
