Department of Graduate Medical Education, Exempla Saint Joseph Hospital, 1835 Franklin Street, Denver, CO 80218, USA.
Am J Surg. 2013 Dec;206(6):876-81; discussion 881-2. doi: 10.1016/j.amjsurg.2013.08.020. Epub 2013 Oct 8.
Hypocalcemia is a common complication of thyroidectomy. The aim of this study was to identify risk factors for this problem.
This prospective analysis included 111 patients undergoing total or completion thyroidectomy. Preoperative vitamin D levels and postoperative day 1 parathyroid hormone levels were analyzed for their predictive effects on postoperative hypocalcemia.
Patients with ionized calcium <4.4 mg/dL had significantly lower mean parathyroid hormone levels than normocalcemic patients (13.0 vs 28.4 pg/mL, P < .001). Parathyroid hormone levels were also significantly lower in symptomatic patients (11.0 vs 28.4 pg/mL, P < .001). Preoperative vitamin D level, body mass index, gender, and pathologic findings were not associated with low calcium levels or symptoms of hypocalcemia.
Younger age and low postoperative parathyroid hormone levels are predictive of symptomatic hypocalcemia. A parathyroid hormone level outside of the reference range may indicate a need for more aggressive postoperative calcium supplementation and treatment with activated vitamin D. Older patients with normal postoperative parathyroid hormone levels may be safely discharged with appropriate calcium supplementation.
低钙血症是甲状腺切除术的常见并发症。本研究旨在确定该问题的危险因素。
这项前瞻性分析包括 111 例行甲状腺全切除术或甲状腺次全切除术的患者。分析了术前维生素 D 水平和术后第 1 天甲状旁腺激素水平对术后低钙血症的预测作用。
离子钙<4.4mg/dL 的患者甲状旁腺激素水平明显低于血钙正常的患者（13.0 比 28.4pg/mL，P<.001）。有症状的患者甲状旁腺激素水平也明显较低（11.0 比 28.4pg/mL，P<.001）。术前维生素 D 水平、体重指数、性别和病理发现与低钙血症或低钙血症症状无关。
年龄较小和术后甲状旁腺激素水平较低是有症状性低钙血症的预测因素。甲状旁腺激素水平超出参考范围可能表明需要更积极的术后补钙和活性维生素 D 治疗。术后甲状旁腺激素水平正常的老年患者可在适当补钙后安全出院。
