Saba Alessandra, Podda Mauro, Messina Campanella Antonio, Pisanu Adolfo
Department of Surgical Science, Azienda Ospedaliero-Universitaria, Presidio Policlinico di Monserrato, University of Cagliari, Blocco G, SS 554 km 4,500, 09042, Monserrato, CA, Italy.
Langenbecks Arch Surg. 2017 Nov;402(7):1119-1125. doi: 10.1007/s00423-017-1586-5. Epub 2017 May 20.
The aim of this randomized-controlled trial was to validate the results of a previous prospective single-cohort observational study conducted in the same surgical unit regarding the use of concomitant intact parathyroid hormone (iPTH) and serum calcium measurement in predicting hypocalcemia after total thyroidectomy.
From January 2014 to January 2015, 150 patients underwent total thyroidectomy in our department and were randomized into two groups. The experimental group was submitted to iPTH assay 6 h after surgery while the control group was submitted to a daily assay of serum calcium and phosphorus. Sensitivity and specificity of different serum measurements have been calculated using the receiver-operator characteristics (ROC) curve.
The prevalence of hypocalcemia was 14.25% in both groups. The assay of iPTH 6 h after surgery combined with the serum calcium assay 24 h after surgery yielded the highest diagnostic accuracy in predicting hypocalcemia using ROC curves, with 100% sensitivity and 100% specificity.
According to our previous study, the combined measurement of iPTH 6 h after surgery and of serum calcium 24 h after surgery are highly predictive of early postoperative hypocalcemia. These results are important in selecting the patients eligible for early discharge and those who need calcium and vitamin D supplementation.
本随机对照试验的目的是验证先前在同一外科单元进行的一项前瞻性单队列观察性研究的结果，该研究涉及使用完整甲状旁腺激素（iPTH）和血清钙测量来预测全甲状腺切除术后的低钙血症。
2014年1月至2015年1月，150例患者在我科接受了全甲状腺切除术，并被随机分为两组。实验组在术后6小时进行iPTH检测，而对照组则每天进行血清钙和磷检测。使用受试者操作特征（ROC）曲线计算不同血清检测的敏感性和特异性。
两组低钙血症的患病率均为14.25%。术后6小时的iPTH检测与术后24小时的血清钙检测相结合，在使用ROC曲线预测低钙血症时具有最高的诊断准确性，敏感性为100%，特异性为100%。
根据我们之前的研究，术后6小时的iPTH和术后24小时的血清钙联合测量对术后早期低钙血症具有高度预测性。这些结果对于选择适合早期出院的患者以及那些需要补充钙和维生素D的患者具有重要意义。
