Department of Surgery, Clinica Chirurgica, University of Cagliari, Monserrato, Italy.
Langenbecks Arch Surg. 2013 Mar;398(3):423-30. doi: 10.1007/s00423-012-1017-6. Epub 2012 Oct 19.
Concomitant intact parathyroid hormone (iPTH) and serum calcium measurement is deemed to be useful in predicting hypocalcemia after total thyroidectomy. This study aimed to prospectively assess the diagnostic accuracy of combined iPTH and serum calcium measurement in predicting early postoperative hypocalcemia.
From January 2010 to January 2011, 112 patients underwent total thyroidectomy in our department. A prospective study was carried out to search for factors predicting postoperative hypocalcemia. Serum calcium, phosphorus, and iPTH levels have been measured before operation and at 6, 24, and 48 h postoperatively. Hypocalcemia was defined as a serum calcium level less than 8.0 mg/dL. Sensitivity and specificity of different serum measurements have been calculated using the receiver-operator characteristics curve.
Thirty-three patients (29.5 %) had transient postoperative hypocalcemia. Serum iPTH level showed the highest sensitivity and specificity in predicting hypocalcemia after 6 h (84.8 % and 93.7 %, respectively) for a criterion value ≤ 12.1 pg/mL. Serum calcium level showed the highest sensitivity and specificity after 24 h (93.9 and 100.0 %, respectively) for a criterion value ≤ 7.97 mg/dL. Combined cutoffs of 6-h iPTH and 24-h serum calcium showed sensitivity and specificity of 100.0 %.
The combined measurement of 6-h iPTH and 24-h serum calcium are highly predictive of early postoperative hypocalcemia. Patients with serum iPTH and calcium level ≤ criterion value are at major risk for developing hypocalcemia. These results are important in selecting patients eligible for early discharge and those patients who need calcium and vitamin D supplementation.
同时检测完整甲状旁腺激素（iPTH）和血清钙水平被认为有助于预测甲状腺全切除术后低钙血症。本研究旨在前瞻性评估联合检测 iPTH 和血清钙对预测甲状腺全切除术后早期低钙血症的诊断准确性。
2010 年 1 月至 2011 年 1 月，我科 112 例患者接受甲状腺全切除术。进行了一项前瞻性研究，以寻找预测术后低钙血症的因素。术前及术后 6、24、48 h 检测血清钙、磷和 iPTH 水平。低钙血症定义为血清钙水平＜8.0 mg/dL。采用受试者工作特征曲线计算不同血清学检测的敏感性和特异性。
33 例（29.5%）患者出现一过性术后低钙血症。术后 6 h，iPTH 水平对预测低钙血症的敏感性和特异性最高（分别为 84.8%和 93.7%，临界值≤12.1 pg/mL）。术后 24 h 时血清钙水平的敏感性和特异性最高（分别为 93.9%和 100.0%，临界值≤7.97 mg/dL）。6 h iPTH 和 24 h 血清钙联合临界值的敏感性和特异性为 100.0%。
6 h iPTH 和 24 h 血清钙联合检测对预测术后早期低钙血症具有高度预测性。iPTH 和血清钙水平均≤临界值的患者发生低钙血症的风险较大。这些结果对于选择有资格提前出院的患者以及需要补充钙和维生素 D 的患者非常重要。
