Castro Alejandro, Oleaga Amelia, Parente Arias Pablo, Paja Miguel, Gil Carcedo Elisa, Álvarez Escolá Cristina
Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, España.
Servicio de Endocrinología y Nutrición, Hospital Universitario de Basurto, Bilbao, España.
Acta Otorrinolaringol Esp (Engl Ed). 2019 Sep-Oct;70(5):301-305. doi: 10.1016/j.otorri.2019.04.001. Epub 2019 Aug 4.
Hypoparathyroidism is the most common complication after total or completion thyroidectomy. It is defined as the presence of hypocalcemia accompanied by low or inappropriately normal parathyroid hormone (PTH) levels. Acute hypocalcemia is a potential lethal complication. Hypocalcemia treatment is based on endovenous or oral calcium supplements as well as oral calcitriol, depending on the severity of the symptoms. The risk of clinical hypocalcemia after bilateral thyroidectomy is considered very low if postoperative intact PTH decrease less than 80% with respect to preoperative levels. These patients could be discharged home without treatment, although this threshold may vary between institutions, and we recommend close surveillance in cases with increased risk (Graves disease, large goiters, reinterventions or evidence of parathyroid gland removal). Long-term treatment objectives are to control the symptoms and to keep serum calcium levels at the lower limit of the normal range, while preserving the calcium phosphate product and avoiding hypercalciuria.
甲状旁腺功能减退是全甲状腺切除术或甲状腺切除术后最常见的并发症。它被定义为伴有低甲状旁腺激素（PTH）水平或甲状旁腺激素水平不适当正常的低钙血症。急性低钙血症是一种潜在的致命并发症。低钙血症的治疗基于静脉或口服钙剂以及口服骨化三醇，具体取决于症状的严重程度。如果术后完整PTH相对于术前水平降低小于80%，双侧甲状腺切除术后临床低钙血症的风险被认为非常低。这些患者可以在不接受治疗的情况下出院回家，尽管不同机构的这个阈值可能有所不同，对于风险增加的病例（格雷夫斯病、大甲状腺肿、再次手术或甲状旁腺切除证据），我们建议密切监测。长期治疗目标是控制症状，将血清钙水平维持在正常范围的下限，同时保持钙磷乘积并避免高钙尿症。
