Pinardo Heinrich, Rubin Samuel J, Hashemi Sean, DePietro Joseph, Pearce Elizabeth N, Ananthakrishnan Sonia, Alexanian Sara M, Steenkamp Devin W, Noordzij Jacob Pieter
Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA.
Department of Medicine, Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston Medical Center, Boston, MA, USA.
Clin Endocrinol (Oxf). 2020 Nov;93(5):598-604. doi: 10.1111/cen.14259. Epub 2020 Jun 16.
To evaluate the use of preoperative vitamin D levels and postoperative vitamin D supplementation among endocrinologists for the prevention of post-thyroidectomy hypocalcaemia.
Endocrinologist members of the American Thyroid Association (ATA) were contacted via email to complete a 21-question survey, which included both questions about demographic information, and preventing and managing postoperative hypocalcaemia after thyroidectomy. Univariate and multivariate analysis was performed to determine the respondents' use of preoperative vitamin D levels, dose and duration of preoperative vitamin D repletion, decision to delay surgery for low vitamin D levels in the case of a benign or malignant disease, and routine prescription of postoperative calcium or vitamin D supplementation.
225 endocrinologists who were ATA members responded to the questionnaire. When compared to endocrinologists practicing in other countries, those that practice in the United States were 2.5 times more likely to check preoperative vitamin D levels (95% CI[1.404, 4.535], P = .002), significantly more likely to replete vitamin D deficient patients with high-dose vitamin D (ie ≥50K IU/week), 4.458 times more likely to prescribe prophylactic supplemental calcium (95% CI[2.446, 8.126]; P < .0001) and 3.48 more likely to prescribe supplemental vitamin D (95% CI [1.906, 6.355]; P < .0001). Endocrinologists who have been in practice for >10 years were also 1.915 times more likely to prescribe supplemental vitamin D (95% CI (1.080, 3.395); P = .0263). Physicians that treat >50 thyroidectomy cases/year were 2.083 more likely to recommend a vitamin D repletion duration of >1 month than those that treat ≤50 cases/year ([1.036, 4.190], P = .0395). Lastly, if the patient has low preoperative vitamin D levels, 47.05% of respondents chose to delay surgery in a benign disease, while only 11.61% of respondents would do so in a case of malignant disease.
Approximately one-half of surveyed endocrinologists reported using preoperative vitamin D levels to assess a patient's risk for post-thyroidectomy hypocalcaemia. Endocrinologists practicing in the United States, compared to those practicing in other countries, were more likely to both test for preoperative vitamin D levels and to recommend prophylactic post-thyroidectomy calcium and vitamin D supplementation.
评估内分泌科医生在预防甲状腺切除术后低钙血症方面对术前维生素D水平的应用及术后维生素D补充情况。
通过电子邮件联系美国甲状腺协会（ATA）的内分泌科医生成员，以完成一项包含21个问题的调查，这些问题既涉及人口统计学信息，也包括预防和处理甲状腺切除术后低钙血症的相关内容。进行单因素和多因素分析，以确定受访者对术前维生素D水平的应用、术前维生素D补充的剂量和持续时间、在良性或恶性疾病情况下因维生素D水平低而延迟手术的决定，以及术后常规补充钙或维生素D的情况。
225名ATA成员内分泌科医生回复了问卷。与在其他国家执业的内分泌科医生相比，在美国执业的医生检查术前维生素D水平的可能性高2.5倍（95%可信区间[1.404, 4.535]，P = 0.002），显著更有可能用高剂量维生素D（即≥50000 IU/周）补充维生素D缺乏的患者，开具预防性补充钙的可能性高4.458倍（95%可信区间[2.446, 8.126]；P < 0.0001），开具补充维生素D的可能性高3.48倍（95%可信区间[1.906, 6.355]；P < 0.0001）。执业超过10年的内分泌科医生开具补充维生素D的可能性也高1.915倍（95%可信区间(1.080, 3.395)；P = 0.0263）。每年治疗超过50例甲状腺切除病例的医生比每年治疗≤50例病例的医生推荐维生素D补充持续时间>1个月的可能性高2.083倍（[1.036, 4.190]，P = 0.0395）。最后，如果患者术前维生素D水平低，47.05%的受访者选择在良性疾病中延迟手术，而在恶性疾病情况下只有11.61%的受访者会这样做。
约一半接受调查的内分泌科医生报告使用术前维生素D水平来评估患者甲状腺切除术后低钙血症的风险。与在其他国家执业的内分泌科医生相比，在美国执业的医生更有可能检测术前维生素D水平，并推荐甲状腺切除术后预防性补充钙和维生素D。
