Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Otorhinolaryngology Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy.
Head Neck. 2019 Nov;41(11):3940-3947. doi: 10.1002/hed.25934. Epub 2019 Aug 31.
Three different strategies to manage transient hypocalcemia after total thyroidectomy were compared to evaluate cost-effectiveness. The reliability of total serum calcium (TSCa), ionized calcium (ICa), and intact parathyroid hormone (iPTH) were investigated to achieve this goal.
A multicenter, prospective randomized study was carried out with 169 patients. The strategies were "preventive" (oral calcium + vitamin D supplementation), "reactive" (therapy in hypocalcemia), and "predictive" (therapy if iPTH <10 pg/mL).
TSCa had higher accuracy in identifying patients who developed hypocalcemia-related symptoms than ICa (84.6% vs 50.0%). TSCa 24 h after surgery showed 24.8% of patients with hypocalcemia, whereas TSCa 48 h after surgery identified a further 10.6% with hypocalcemia (only in the "reactive" and "predictive" groups). iPTH showed low sensitivity as a predictor of hypocalcemia. Between the 3 groups, there was no significant difference in hospitalization time or number of symptomatic hypocalcemic patients. Interestingly, the cost-per-patient was significantly different among the groups.
None of the discussed strategies allowed for early discharge of patients without any risk of transient hypocalcemia. The "preventive" strategy was the most cost-effective, despite overtreatment.
为了评估成本效益，比较了三种不同的策略来管理全甲状腺切除术后的短暂性低钙血症。研究了总血清钙（TSCa）、离子钙（ICa）和完整甲状旁腺激素（iPTH）的可靠性，以实现这一目标。
对 169 例患者进行了一项多中心前瞻性随机研究。策略是“预防性”（口服钙+维生素 D 补充）、“反应性”（低钙血症时治疗）和“预测性”（iPTH <10pg/mL 时治疗）。
与 ICa（50.0%）相比，TSCa 更能准确识别出现低钙血症相关症状的患者（84.6%）。术后 24 小时 TSCa 显示 24.8%的患者发生低钙血症，而术后 48 小时 TSCa 进一步识别出 10.6%的患者发生低钙血症（仅在“反应性”和“预测性”组）。iPTH 作为低钙血症的预测指标敏感性较低。三组间住院时间或有症状性低钙血症患者的数量无显著差异。有趣的是，三组间的患者成本存在显著差异。
所讨论的策略均不能在不增加短暂性低钙血症风险的情况下让患者提前出院。尽管存在过度治疗，但“预防性”策略最具成本效益。
