Department of Surgery, Kyung Hee University School of Medicine, Seoul, South Korea.
Int J Surg. 2016 Oct;34:47-52. doi: 10.1016/j.ijsu.2016.08.019. Epub 2016 Aug 20.
The aim of this study was to evaluate the risk factors for hypoparathyroidism after total thyroidectomy and to determine whether early postoperative serum levels of calcium and phosphorus could be used to predict its development.
The study group consisted of 1030 patients who had undergone total thyroidectomy at our institution between March 2008 and July 2014. The clinicopathologic characteristics, indications for the operation, and surgical details of normocalcemic and hypocalcemic patients were compared, and variations in serum calcium and phosphorus levels were measured every day after the operation.
Of the 1030 patients, 291 (28.2%) were found to have transient hypocalcemia and 27 (2.6%) had permanent hypocalcemia. On univariate analysis, younger age (P = 0.001), female gender (P < 0.001), longer operative time (P = 0.009), extent of central neck dissection (CND) (P = 0.003), and malignancy (P = 0.005) were found to be significantly associated with transient hypocalcemia. On multivariate analysis, female gender (P = 0.001), extent of CND (P = 0.017), and the identification of parathyroid gland (PTG) tissue in permanent pathologic sections were significant factors. In addition, the occurrence of postoperative hypocalcemia was correlated with relative changes in serum calcium and phosphorus levels. Patients whose serum calcium levels decreased over 20% on postoperative day 2 were more likely to develop hypoparathyroidism, with 92% specificity.
Female gender (P = 0.001), extent of CND (P = 0.014), and PTG in permanent pathologic sections (P = 0.035) were found to be significant factors affecting the development of hypocalcemia. Despite some study limitations, we suggest that the relative changes in the serum levels of calcium (20%) and of phosphorus (40%) on the second postoperative day may be reliable predictors of post-thyroidectomy hypoparathyroidism.
本研究旨在评估甲状腺全切除术后甲状旁腺功能减退的风险因素，并确定术后早期血清钙、磷水平是否可用于预测其发生。
研究组纳入 2008 年 3 月至 2014 年 7 月期间在我院行甲状腺全切除术的 1030 例患者。比较血钙正常与低钙血症患者的临床病理特征、手术适应证及手术细节，术后每天测量血清钙、磷水平。
1030 例患者中，291 例（28.2%）发生一过性低钙血症，27 例（2.6%）发生永久性低钙血症。单因素分析显示，年龄较轻（P=0.001）、女性（P<0.001）、手术时间较长（P=0.009）、中央区淋巴结清扫范围较大（P=0.003）、恶性肿瘤（P=0.005）与一过性低钙血症显著相关。多因素分析显示，女性（P=0.001）、中央区淋巴结清扫范围（P=0.017）、永久性病理切片中甲状旁腺组织的识别（P=0.035）是显著相关因素。此外，术后低钙血症的发生与血清钙、磷水平的相对变化有关。术后第 2 天血清钙降低超过 20%的患者发生甲状旁腺功能减退的可能性更大，特异性为 92%。
女性（P=0.001）、中央区淋巴结清扫范围（P=0.014）、永久性病理切片中甲状旁腺组织（P=0.035）是影响低钙血症发生的显著因素。尽管存在一些研究局限性，但我们认为术后第 2 天血清钙（20%）和磷（40%）的相对变化可能是预测甲状腺切除术后甲状旁腺功能减退的可靠指标。
