Oltmann Sarah C, Brekke Andrew V, Schneider David F, Schaefer Sarah C, Chen Herbert, Sippel Rebecca S
Department of Surgery, Section of Endocrine Surgery, University of Wisconsin, Madison, WI, USA.
Ann Surg Oncol. 2015 Mar;22(3):952-8. doi: 10.1245/s10434-014-4077-8. Epub 2014 Sep 12.
Hypocalcemia occurs after total thyroidectomy (TT) for Graves disease via parathyroid injury and/or from increased bone turnover. Current management is to supplement calcium after surgery. This study evaluates the impact of preoperative calcium supplementation on hypocalcemia after Graves TT.
A prospective study of patients with Graves disease undergoing TT was performed. Patients with Graves disease managed over a 9-month period took 1 g of calcium carbonate (CC) three times a day for 2 weeks before TT. Those managed the previous year without supplementation served as historic controls. Age-, gender-, and thyroid weight-matched, non-Graves TT patients were procedure controls. Patient demographics, postoperative laboratory values, complaints, and medications were reviewed. Parathyroid hormone (PTH)-based postoperative protocols dictated postoperative CC and calcitriol use.
Forty-five patients with Graves disease were treated with CC before TT, and 38 patients with Graves disease were not. Forty control subjects without Graves disease were identified. Age, gender, and thyroid weight were comparable. Preoperative calcium and PTH levels were equivalent. PTH values immediately after surgery, at postoperative day 1, and at 2-week follow-up were equivalent. Postoperative use of scheduled CC (p = 0.10) and calcitriol (p = 0.60) was similar. Postoperatively, patients with untreated Graves disease had lower serum calcium levels than pretreated patients with Graves disease or control subjects without Graves disease (8.3 mg/dL vs. 8.6 vs. 8.6, p = 0.05). Complaints of numbness and tingling were more common in nontreated Graves disease (26%) than in pretreated Graves disease (9%) or in control subjects without Graves disease (10%, p < 0.05).
Calcium supplementation before TT for Graves disease significantly reduced biochemical and symptomatic postoperative hypocalcemia. Preoperative calcium supplementation is a simple treatment that can reduce symptoms of hypocalcemia after Graves TT.
格雷夫斯病患者行全甲状腺切除术后，甲状旁腺损伤和/或骨转换增加会导致低钙血症。目前的治疗方法是术后补充钙剂。本研究评估术前补充钙剂对格雷夫斯病全甲状腺切除术后低钙血症的影响。
对行全甲状腺切除术的格雷夫斯病患者进行前瞻性研究。在9个月期间接受治疗的格雷夫斯病患者在全甲状腺切除术前2周每天服用1克碳酸钙（CC），分三次服用。前一年未接受补充治疗的患者作为历史对照。年龄、性别和甲状腺重量匹配的非格雷夫斯病全甲状腺切除患者作为手术对照。回顾患者的人口统计学资料、术后实验室检查值、主诉和用药情况。基于甲状旁腺激素（PTH）的术后方案规定了术后碳酸钙和骨化三醇的使用。
45例格雷夫斯病患者在全甲状腺切除术前接受了碳酸钙治疗，38例未接受。确定了40例无格雷夫斯病的对照受试者。年龄、性别和甲状腺重量具有可比性。术前钙和PTH水平相当。术后即刻、术后第1天和2周随访时的PTH值相当。术后预定碳酸钙（p = 0.10）和骨化三醇（p = 0.60）的使用情况相似。术后，未治疗的格雷夫斯病患者血清钙水平低于接受过治疗的格雷夫斯病患者或无格雷夫斯病的对照受试者（8.3mg/dL对8.6对8.6，p = 0.05）。未治疗的格雷夫斯病患者中麻木和刺痛的主诉（26%）比接受过治疗的格雷夫斯病患者（9%）或无格雷夫斯病的对照受试者（10%，p < 0.05）更常见。
格雷夫斯病患者全甲状腺切除术前补充钙剂可显著降低术后生化性和症状性低钙血症。术前补充钙剂是一种简单的治疗方法，可减轻格雷夫斯病全甲状腺切除术后低钙血症的症状。
