Rosa Karen Manoela, Matos Leandro Luongo de, Cernea Cláudio Roberto, Brandão Lenine Garcia, Araújo Filho Vergilius José Furtado de
Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Departamento de Cirurgia, Universidade de São Paulo, São Paulo, SP, Brazil.
Arch Endocrinol Metab. 2015 Oct;59(5):428-33. doi: 10.1590/2359-3997000000074. Epub 2015 Jul 21.
The aim of the present study was to identify a fast, efficient and low-cost method to diagnose hypoparathyroidism after total thyroidectomy.
One hundred and forty medical records, which contained patients' clinical and laboratory data, were retrospectively analyzed. Patient parathyroid hormone values, which were obtained immediately following operation, were compared with their ionized calcium levels the morning after surgery. This comparison was used to examine the correlation between the two variables in predicting hypoparathyroidism because measuring calcium levels is low-cost and more available in the hospitals compared to measuring parathormone (PTH) levels.
There was a positive and statistically significant correlation between PTH and ionized calcium values (Pearson correlation coefficient, r = 0.456; p < 0.0001). The values of first postoperative day ionized calcium levels (stratified by the 1.10 mmol/l cut-off value) were tested as a diagnostic measure for hypoparathyroidism, and a PTH < 15 pg/mL obtained immediately following operation served as a reference. This analysis showed that ionized calcium levels measured on the first postoperative day had a sensitivity of 45.6% (95% CI 30.9-61.0%), a specificity of 88.9% (95% CI 80.5-94.5%) and an accuracy of 76.7% (95% CI 68.7-83.5%) as a diagnostic measure for hypoparathyroidism.
In conclusion, we demonstrated that patients who had high ionized calcium levels on the first postoperative day also had high PTH levels immediately following operation and, therefore, they had lower rates of hypoparathyroidism.
本研究的目的是确定一种快速、高效且低成本的方法来诊断全甲状腺切除术后的甲状旁腺功能减退症。
回顾性分析140份包含患者临床和实验室数据的病历。将患者术后即刻获得的甲状旁腺激素值与其术后次日早晨的离子钙水平进行比较。由于与测量甲状旁腺激素（PTH）水平相比，测量钙水平成本较低且在医院更易获得，因此该比较用于检查这两个变量在预测甲状旁腺功能减退症方面的相关性。
PTH与离子钙值之间存在正相关且具有统计学意义（Pearson相关系数，r = 0.456；p < 0.0001）。将术后第一天离子钙水平的值（按1.10 mmol/l的临界值分层）作为甲状旁腺功能减退症的诊断指标进行测试，并将术后即刻获得的PTH < 15 pg/mL作为参考。该分析表明，术后第一天测量的离子钙水平作为甲状旁腺功能减退症的诊断指标，敏感性为45.6%（95%可信区间30.9 - 61.0%），特异性为88.9%（95%可信区间80.5 - 94.5%），准确性为76.7%（95%可信区间68.7 - 83.5%）。
总之，我们证明了术后第一天离子钙水平高的患者术后即刻PTH水平也高，因此他们发生甲状旁腺功能减退症的几率较低。
