Al-Dhahri Saleh F, Mubasher Mohamed, Al-Muhawas Fida, Alessa Mohammed, Terkawi Rayan S, Terkawi Abdullah S
Department of Otolaryngology, Head and Neck Surgery, King Fahad Medical City, Riyadh, Saudi Arabia Department of Otolaryngology, Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia.
Department of Biostatistics, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia.
Otolaryngol Head Neck Surg. 2014 Sep;151(3):407-14. doi: 10.1177/0194599814536848. Epub 2014 Jun 5.
To optimize and individualize post-thyroidectomy hypocalcemia management.
A multicenter prospective cohort study.
Two tertiary care hospitals.
parathyroid hormone (PTH) was measured preoperatively, then at 1 and 6 hours after surgery. The required doses of calcium and vitamin D were defined as those maintaining the patients asymptomatic and their cCa ≥ 2 mmol/L. They were used as an endpoint in a generalized linear mixed effect model (GLIMMEX) aiming to identify the best predictors of these optimal required doses. Models were evaluated by goodness of fit and Receiver Operating Characteristic (ROC) curves.
One hundred and sixty-eight patients were analyzed; 85.1% were female, 49.3% had BMI > 30, and 64% had vitamin D deficiency. Post-thyroidectomy hypocalcemia was found in 25.6%, of whom 18 (41.9%) were symptomatic and received intravenous calcium. First hour percentage of drop in PTH correlated positively with the severity of hypocalcemia (P < .0001). The GLIMMIX prediction model for oral calcium requirement was based on first-hour percentage change from preoperative PTH level, preoperative actual PTH, BMI, and thyroid function. The same predictors were identified for vitamin D, except that thyroid function was replaced with vitamin D status. These factors were used to build predictive equations for calcium and vitamin D doses.
Our findings help to optimize management of post-thyroidectomy hypocalcemia by assisting in the early identification of those who are not at risk of hypocalcaemia and by guiding early effective management of those at risk. This may reduce complications and medical cost.
优化甲状腺切除术后低钙血症的管理并实现个体化。
一项多中心前瞻性队列研究。
两家三级医疗医院。
术前、术后1小时和6小时测量甲状旁腺激素（PTH）。将维持患者无症状且校正总钙（cCa）≥2 mmol/L所需的钙和维生素D剂量定义为目标剂量。在广义线性混合效应模型（GLIMMEX）中，将这些目标剂量用作终点，旨在确定这些最佳所需剂量的最佳预测因素。通过拟合优度和受试者工作特征（ROC）曲线对模型进行评估。
分析了168例患者；85.1%为女性，49.3%的体重指数（BMI）>30，64%存在维生素D缺乏。甲状腺切除术后低钙血症的发生率为25.6%，其中18例（41.9%）出现症状并接受了静脉补钙。术后第1小时PTH下降百分比与低钙血症严重程度呈正相关（P<.0001）。口服钙剂需求量的GLIMMIX预测模型基于术前PTH水平、术前实际PTH、BMI和甲状腺功能的第1小时百分比变化。维生素D的预测因素相同，只是用维生素D状态取代了甲状腺功能。利用这些因素建立了钙和维生素D剂量的预测方程。
我们的研究结果有助于优化甲状腺切除术后低钙血症的管理，通过协助早期识别无低钙血症风险的患者，并指导对有风险患者进行早期有效管理。这可能会减少并发症和医疗费用。
