4 小时术后甲状旁腺激素水平可预测儿童甲状腺切除术后低钙血症。

4-Hour postoperative PTH level predicts hypocalcemia after thyroidectomy in children.

机构信息

Division of Pediatric Surgery, Department of Surgery, University of Michigan, 1540 E Hospital Dr. Rm 4972, Ann Arbor, MI 48109.

Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, University of Michigan, 1500 E Medical Center Dr, D1205 MPB, Ann Arbor, MI 48109.

出版信息

J Pediatr Surg. 2020 Jul;55(7):1265-1269. doi: 10.1016/j.jpedsurg.2019.11.014. Epub 2019 Dec 16.

DOI:10.1016/j.jpedsurg.2019.11.014

PMID:31892477

Abstract

BACKGROUND

Hypocalcemia occurs frequently after a total thyroidectomy in pediatric patients. Four hour postoperative PTH monitoring predicts the need for calcium supplementation in the adult thyroidectomy population. We evaluated the role of the 4 h postoperative PTH level in determining the need for calcium supplementation after thyroidectomy in the pediatric population.

METHODS

This is a retrospective review of children undergoing total thyroidectomy by a single pediatric surgeon from July 2011 through July 2018. Intact PTH obtained four hours postoperatively determined the need for calcium supplementation for patients beginning in November 2014 onward. Serum total calcium levels were monitored concurrently with serum intact PTH levels. Serum calcium levels were followed in our Multispecialty Pediatric Endocrine Surgery clinic within the month following thyroidectomy.

RESULTS

From July 2011 through July 2018, there were a total of 56 total thyroidectomies at our institution. Prior to November 2014, all pediatric total thyroidectomies received calcium supplementation per our institutional protocol. Based on ionized calcium levels, 26.3% (5/19) of children developed hypocalcemia. From November 2014 to July 2018, 37 pediatric patients required total thyroidectomies. 29.7% (11/37) had low 4-h postoperative PTH levels. 72.7% (8/11) patients with low 4-h postoperative PTH levels had corresponding postoperative day 1 total calcium levels less than 8.5 or ionized calcium levels less than 1.12, and five children (45.5%) developed symptomatic hypocalcemia. 70% (26/37) of children had normal 4-h postop PTH levels, with only 5 (19%) ever developing hypocalcemia. No patients with a normal postop PTH level developed symptomatic hypocalcemia or required IV calcium repletion. A single 4-h postoperative PTH <10 pg/dl for identifying hypocalcemia has a sensitivity of 81% and specificity of 91%, with AUC 0.81.

CONCLUSION

The 4-h postoperative serum PTH level can help determine the need for calcium supplementation in pediatric patients undergoing total thyroidectomy, thereby reducing unnecessary calcium supplementation and serial lab draws to monitor for postoperative hypocalcemia.

LEVEL OF EVIDENCE

Level II.

摘要

背景

在小儿甲状腺全切除术后常发生低钙血症。术后 4 小时 PTH 监测可预测成人甲状腺切除术后人群补钙的需要。我们评估了术后 4 小时 PTH 水平在确定小儿甲状腺切除术后补钙需求中的作用。

方法

这是对 2011 年 7 月至 2018 年 7 月期间由一名儿科外科医生进行的小儿甲状腺全切除术的回顾性研究。术后 4 小时获得的完整 PTH 决定了从 2014 年 11 月开始需要补钙的患者。同时监测血清总钙和血清完整 PTH 水平。甲状腺切除术后一个月内，在我们的多专科儿科内分泌外科诊所中监测血钙水平。

结果

2011 年 7 月至 2018 年 7 月，我院共进行了 56 例甲状腺全切除术。在 2014 年 11 月之前，根据我们的机构方案，所有小儿甲状腺全切除术均接受补钙治疗。根据离子钙水平，26.3%（5/19）的儿童出现低钙血症。2014 年 11 月至 2018 年 7 月，37 例小儿患者需行甲状腺全切除术。29.7%（11/37）的患者术后 4 小时 PTH 水平较低。72.7%（8/11）的低术后 4 小时 PTH 水平患者术后第 1 天总钙水平<8.5 或离子钙水平<1.12，5 例患儿（45.5%）出现症状性低钙血症。70%（26/37）的患儿术后 4 小时 PTH 水平正常，仅 5 例（19%）发生低钙血症。无术后 PTH 水平正常的患儿出现症状性低钙血症或需要静脉补钙。术后 4 小时单次 PTH <10 pg/dl 诊断低钙血症的敏感性为 81%，特异性为 91%，AUC 为 0.81。