Huang Shih-Ming
Department of General Surgery, College of Medicine and Hospital, National Cheng-Kung University, No. 138, Sheng Li Road, 704, Tainan, Taiwan, R.O.C.
World J Surg. 2012 Jul;36(7):1503-8. doi: 10.1007/s00268-012-1580-6.
Calcium and calcitriol supplements are standard for patients with post-thyroidectomy serum calcium <2.0 mmol/L; however, we wondered whether we overtreat post-thyroidectomy hypocalcemia with intraoperative parathyroid hormone (PTH). We examined quick-intraoperative intact PTH (QiPTH) assay results to find a suitable treatment for post-thyroidectomy hypocalcemia.
We studied 197 bilateral thyroidectomy patients. Post-thyroidectomy hypocalcemia was defined as serum calcium <2.0 mmol/L. A QiPTH assay was done 15 min after the thyroidectomy (QiPTH(15)), and hypoparathyroidism was defined as PTH <15 ng/L. The QiPTH(15) assay was used to determine the effects of the thyroidectomy on postoperative PTH levels and serum calcium levels. The natural course and medical response of hypocalcemia was observed in patients with a QiPTH(15) ≥ 15 ng/L.
None of the 187 patients with a QiPTH(15) ≥ 15 ng/L developed postoperative hypoparathyroidism. However, 79 patients developed transient hypocalcemia, and those with Graves' disease (47/94) had significantly (p < 0.05) higher hypocalcemia than those with non-Graves' thyroid disease (32/93). The serum calcium of these 79 patients declined to its lowest level within the first postoperative 18 h. Seven patients with serum calcium <1.75 mmol/L were successfully treated using a calcium supplement only, and the others recovered spontaneously without treatment.
When post-thyroidectomy QiPTH(15) was ≥ 15 ng/L, postoperative hypoparathyroidism was excluded, but more than one-third of the patients developed post-thyroidectomy hypocalcemia. However, most of them recovered without treatment, and a few recovered after taking only a calcium supplement. We believe that using QiPTH(15) results as a guide will prevent overtreatment of post-thyroidectomy hypocalcemia.
对于甲状腺切除术后血清钙<2.0 mmol/L的患者，补充钙和骨化三醇是标准治疗方法；然而，我们想知道术中甲状旁腺激素（PTH）是否会导致我们对甲状腺切除术后低钙血症过度治疗。我们检查了术中快速完整PTH（QiPTH）检测结果，以寻找适合甲状腺切除术后低钙血症的治疗方法。
我们研究了197例双侧甲状腺切除术患者。甲状腺切除术后低钙血症定义为血清钙<2.0 mmol/L。甲状腺切除术后15分钟进行QiPTH检测（QiPTH(15)），甲状旁腺功能减退定义为PTH<15 ng/L。QiPTH(15)检测用于确定甲状腺切除术对术后PTH水平和血清钙水平的影响。观察QiPTH(15)≥15 ng/L患者低钙血症的自然病程和药物反应。
187例QiPTH(15)≥15 ng/L的患者均未发生术后甲状旁腺功能减退。然而，79例患者发生了短暂性低钙血症，其中格雷夫斯病患者（47/94）的低钙血症发生率显著高于非格雷夫斯甲状腺疾病患者（32/93）（p<0.05）。这79例患者的血清钙在术后18小时内降至最低水平。7例血清钙<1.75 mmol/L的患者仅通过补充钙剂成功治疗，其他患者未经治疗自行恢复。
当甲状腺切除术后QiPTH(15)≥15 ng/L时，可排除术后甲状旁腺功能减退，但超过三分之一的患者发生了甲状腺切除术后低钙血症。然而，大多数患者未经治疗即可恢复，少数患者仅补充钙剂后即可恢复。我们认为，以QiPTH(15)检测结果为指导可避免对甲状腺切除术后低钙血症的过度治疗。
