Department of Surgery, Skåne University Hospital-Lund, 221 85, Lund, Sweden.
World J Surg. 2012 Aug;36(8):1933-42. doi: 10.1007/s00268-012-1574-4.
For reasons that remain unclear, surgery for Graves' disease is associated with a higher risk of hypocalcemia than surgery for benign atoxic goiter. In the present study, we evaluated risk factors for postoperative hypocalcemia in patients undergoing operation for Graves' disease.
Data from 1,157 patients who underwent operation for Graves' disease between 2004 and 2008 were extracted from the Scandinavian database for Thyroid and Parathyroid Surgery. Risk factors for postoperative hypocalcemia (in-hospital i. v. calcium; treatment with vitamin D analog at discharge, at 6 weeks, and at 6 months postoperatively) were evaluated by logistic regression analysis.
Risk factors for i. v. calcium were low hospital volume of thyroid surgery (odds ratio [OR]: 95 % confidence interval [95 % CI], 0.99: 0.99-1.00), age (0.95: 0.91-1.00), operative time (1.02: 1.01-1.02), university hospital (12.91: 2.68-62.30), and reoperation for bleeding (10.32: 1.51-70.69). The risk for treatment with vitamin D at discharge increased with operative time (1.01: 1.00-1.02), excised gland weight (1.01: 1.00-1.01), parathyroid autotransplantation (5.19: 2.28-11.84), and reoperation for bleeding (12.00: 2.43-59.28). At 6 weeks, vitamin D medication was associated with gland weight (1.00: 1.00-1.01), and preoperative medication with β-blockers (4.20: 1.67-10.55). At 6 months, vitamin D medication was associated with gland weight (1.00: 1.00-1.01) and reoperation for bleeding (10.59: 1.58-71.22).
Risk factors for medically treated hypocalcemia varied at different times of follow-up. Young age, operative time, type of hospital, and parathyroid autotransplantation were associated with early postoperatively hypocalcemia. Preoperative β-blocker treatment was a risk factor at the first follow-up. At early and late follow-up, gland weight and reoperation for bleeding were associated with medically treated hypocalcemia.
目前尚不清楚的原因是，格雷夫斯病的手术与甲状腺功能亢进症手术后低钙血症的风险高于良性非毒性甲状腺肿的手术。在本研究中，我们评估了格雷夫斯病患者手术治疗后低钙血症的危险因素。
从 2004 年至 2008 年在斯堪的纳维亚甲状腺和甲状旁腺手术数据库中提取了 1157 例接受格雷夫斯病手术的患者的数据。通过逻辑回归分析评估了术后低钙血症（住院静脉注射钙；出院时、6 周时和 6 个月时用维生素 D 类似物治疗）的危险因素。
静脉注射钙的危险因素包括甲状腺手术的医院容量低（优势比[OR]：95%置信区间[95%CI]，0.99:0.99-1.00）、年龄（0.95:0.91-1.00）、手术时间（1.02:1.01-1.02）、大学医院（12.91:2.68-62.30）和因出血而再手术（10.32:1.51-70.69）。出院时使用维生素 D 的风险随着手术时间（1.01:1.00-1.02）、切除腺体重（1.01:1.00-1.01）、甲状旁腺自体移植（5.19:2.28-11.84）和因出血而再手术（12.00:2.43-59.28）而增加。6 周时，维生素 D 药物与腺体重（1.00:1.00-1.01）有关，术前β-阻滞剂治疗与β受体阻滞剂（4.20:1.67-10.55）有关。6 个月时，维生素 D 药物与腺体重（1.00:1.00-1.01）和因出血而再手术（10.59:1.58-71.22）有关。
接受药物治疗的低钙血症的危险因素在不同的随访时间有所不同。年龄较轻、手术时间、医院类型和甲状旁腺自体移植与术后早期低钙血症有关。术前β受体阻滞剂治疗是首次随访的危险因素。在早期和晚期随访中，腺体重量和因出血而再手术与药物治疗的低钙血症有关。
