Division of Endocrine Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
Ann Surg Oncol. 2013 Mar;20(3):739-45. doi: 10.1245/s10434-012-2666-y. Epub 2012 Sep 12.
Although some studies have suggested that low preoperative 25-hydroxyvitamin D (25-OHD) levels may increase the risk of hypocalcemia and decrease the accuracy of single quick parathyroid hormone in predicting hypocalcemia after total thyroidectomy, the literature remains scarce and inconsistent. Our study aimed to address these issues.
Of the 281 consecutive patients who underwent a total/completion total thyroidectomy, 244 (86.8%) did not require any oral calcium and/or calcitriol supplements (group 1), while 37 (13.2%) did (group 2) at hospital discharge. 25-OHD level was checked 1 day before surgery, and postoperative quick parathyroid hormone (PTH) was checked at skin closure (PTH-SC). Postoperative serum calcium was checked regularly. Hypocalcemia was defined by the presence of symptoms or adjusted calcium of <1.90 mmol/L. Significant factors for hypocalcemia were determined by univariate and multivariate analyses. The accuracy of PTH-SC in predicting hypocalcemia was measured by area under a receiver operating characteristic curve (AUC), and the AUC of PTH-SC was compared between patients with preoperative 25-OHD <15 and ≥15 ng/mL via bootstrapping.
Preoperative 25-OHD level was not significantly different between groups 1 and 2 (13.1 vs. 12.5 ng/mL, p = 0.175). After adjusting for other significant factors, PTH-SC (odds ratio 2.49, 95% confidence interval 1.52-4.07, p < 0.001) and parathyroid autotransplantation (odds ratio 3.23, 95% confidence interval 1.22-8.60, p = 0.019) were the two independent factors for hypocalcemia. The AUC of PTH-SC was similar between those with 25-OHD <15 and ≥15 ng/mL (0.880 vs. 0.850, p = 0.61)
Low 25-OHD was not a significant factor for hypocalcemia and did not lower the accuracy of quick PTH in predicting postthyroidectomy hypocalcemia.
尽管一些研究表明，术前低 25-羟维生素 D（25-OHD）水平可能会增加低钙血症的风险，并降低单次快速甲状旁腺激素在预测全甲状腺切除术后低钙血症中的准确性，但文献仍然很少且不一致。我们的研究旨在解决这些问题。
在 281 例连续接受全甲状腺切除术/完成性全甲状腺切除术的患者中，244 例（86.8%）在出院时无需任何口服钙和/或骨化三醇补充剂（组 1），37 例（13.2%）需要（组 2）。手术前一天检查 25-OHD 水平，皮内闭合时检查术后快速甲状旁腺激素（PTH）（PTH-SC）。定期检查术后血清钙。低钙血症定义为存在症状或调整钙<1.90mmol/L。通过单变量和多变量分析确定低钙血症的显著因素。通过接收者操作特征曲线（ROC）下面积（AUC）衡量 PTH-SC 预测低钙血症的准确性，并通过 bootstrap 比较术前 25-OHD<15ng/mL 和≥15ng/mL 患者的 PTH-SC AUC。
组 1 和组 2 之间的术前 25-OHD 水平无显著差异（13.1 vs. 12.5ng/mL，p=0.175）。在调整其他显著因素后，PTH-SC（比值比 2.49，95%置信区间 1.52-4.07，p<0.001）和甲状旁腺自体移植（比值比 3.23，95%置信区间 1.22-8.60，p=0.019）是低钙血症的两个独立因素。25-OHD<15ng/mL 和≥15ng/mL 患者的 PTH-SC AUC 相似（0.880 vs. 0.850，p=0.61）。
低 25-OHD 不是低钙血症的显著因素，也不会降低快速 PTH 在预测甲状腺切除术后低钙血症中的准确性。
