终末期肾病合并正常甲状腺功能的继发性甲状旁腺功能亢进症患者术后一过性甲状腺毒症状态的临床研究。

Clinical study on the status of transient thyrotoxicosis after surgery for secondary hyperparathyroidism patients with end-stage renal disease and normal thyroid function.

机构信息

Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 You Yi Rd, Chongqing, 400016, China.

出版信息

Eur J Med Res. 2020 Mar 17;25(1):7. doi: 10.1186/s40001-020-00405-6.

DOI:10.1186/s40001-020-00405-6

PMID:32183885

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7079515/

Abstract

OBJECTIVE

Secondary hyperparathyroidism (SHPT) is a common complication of end-stage renal disease (ESRD), and part of SHPT patients need receive parathyroidectomy (PTX). However, as an important postoperative complication of SHPT, thyrotoxicosis has received little attention. Therefore, in this article, we aimed to study the status of transient thyrotoxicosis after PTX for SHPT patients with ESRD and normal thyroid function.

METHODS

A total of 24 SHPT patients with preoperative normal thyroid function, normal thyroglobulin (Tg) and normal thyroid antibodies receiving PTX were enrolled from the Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, from January 2017 to January 2019. Tg, high sensitivity thyrotropin stimulating hormone (sTSH), triiodothyronine (T3), free triiodothyronine (fT3), thyroxine (T4) and free thyroxine (fT4) were evaluated the day before PTX and on day 1, 3 and 5 after PTX. Besides, all enrolled patients were evaluated whether there are symptoms associated with thyrotoxicosis.

RESULTS

Among the 24 SHPT patients, 1 case (4.2%), 8 cases (33.3%) and 13 cases (54.2%) had suffered thyrotoxicosis at the first, third and fifth day after surgery, respectively. Serum FT4 level increased significantly from pre-operation (0.68 ± 0.15 ng/dl, normal range 0.59-1.25 ng/dl) to the third day after operation (1.91 ± 0.97 ng/dl, p<0.001) and then gradually decline. The frequencies of serum sTSH lower than the normal level gradually increased from the first day (8.3%) to fifth day (66.7%) after surgery.

CONCLUSION

Transient thyrotoxicosis is a common postoperative complication of parathyroidectomy for SHPT patients with ESRD and normal thyroid function, and it is necessary for clinicians to evaluate the perioperative thyroid function to make early diagnosis and appropriate prevention and treatment of thyrotoxicosis.

摘要

目的

继发性甲状旁腺功能亢进症（SHPT）是终末期肾病（ESRD）的常见并发症，部分 SHPT 患者需要接受甲状旁腺切除术（PTX）。然而，作为 SHPT 的一个重要术后并发症，甲状腺功能亢进症（甲亢）并未受到太多关注。因此，本文旨在研究 ESRD 合并正常甲状腺功能的 SHPT 患者在接受 PTX 后出现短暂性甲亢的情况。

方法

本研究纳入了 2017 年 1 月至 2019 年 1 月期间在重庆医科大学第一附属医院内分泌乳腺外科接受 PTX 的 24 例术前甲状腺功能正常、甲状腺球蛋白（Tg）和甲状腺抗体正常的 SHPT 患者。在 PTX 前一天和术后第 1、3、5 天评估 Tg、高敏促甲状腺激素刺激激素（sTSH）、三碘甲状腺原氨酸（T3）、游离三碘甲状腺原氨酸（fT3）、甲状腺素（T4）和游离甲状腺素（fT4）。此外，所有纳入的患者均评估是否有甲亢相关症状。

结果

24 例 SHPT 患者中，术后第 1、3、5 天分别有 1 例（4.2%）、8 例（33.3%）和 13 例（54.2%）发生甲亢。术后第 3 天血清 FT4 水平较术前显著升高（0.68±0.15ng/dl，正常范围 0.59-1.25ng/dl，p<0.001），随后逐渐下降。术后第 1 天（8.3%）至第 5 天（66.7%）血清 sTSH 低于正常水平的频率逐渐升高。