Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Surgery, ZGT Hospital, Almelo/Hengelo, The Netherlands.
Eur J Endocrinol. 2020 Aug;183(2):149-159. doi: 10.1530/EJE-20-0116.
Hypoparathyroidism is a common complication after thyroidectomy. It is not yet possible to predict in which patients hypoparathyroidism will persist. We aim to determine whether a decrease in PTH levels, measured at the first postoperative day, can identify patients with a high risk for persistent hypoparathyroidism one year after thyroidectomy.
Prospective multi-center cohort study.
Patients undergoing total or completion thyroidectomy were included. We measured PTH levels preoperatively and on the first postoperative day. Primary outcome is the proportion of patients with persistent hypoparathyroidism, defined as the need for calcium supplementation one year after surgery.
We included 110 patients of which 81 were used for analysis of the primary outcome. At discharge 72.8% of patients were treated with calcium supplementation. Persistent hypoparathyroidism was present in 14 patients (17.3%) at one-year follow-up, all of them had a decrease in PTH >70% at the first postoperative day. These 14 were 43.8% of the 32 patients who had such a decrease. In the group of 49 patients (59.8%) without a PTH >70% decrease, none had persistent hypoparathyroidism one year after surgery (P-value <0.001). A decrease of >70% in PTH levels had a sensitivity of 100.0% (95% CI: 85.8-100.0%), a specificity of 73.1% (95% CI: 62.5-83.7%) and an area under the curve of 0.87 (95% CI: 0.79-0.94) to predict the risk for persistent hypoparathyroidism.
In our study a decrease in PTH levels of >70% after total or completion thyroidectomy is a reliable predictor for persistent hypoparathyroidism, and this should be confirmed in larger cohorts.
甲状旁腺功能减退症是甲状腺切除术后的常见并发症。目前尚无法预测哪些患者会持续发生甲状旁腺功能减退症。我们旨在确定术后第一天测量的甲状旁腺激素（PTH）水平下降是否可以识别出甲状腺全切除或近全切除术后一年持续发生甲状旁腺功能减退症的高危患者。
前瞻性多中心队列研究。
纳入接受甲状腺全切除或近全切除的患者。我们分别在术前和术后第一天测量 PTH 水平。主要结局是术后一年持续甲状旁腺功能减退症的患者比例，定义为术后需要补钙。
我们纳入了 110 例患者，其中 81 例用于分析主要结局。出院时，72.8%的患者接受了补钙治疗。术后一年随访时，14 例（17.3%）患者出现持续性甲状旁腺功能减退症，他们在术后第一天的 PTH 下降均>70%。这 14 例患者占 PTH 下降>70%的 32 例患者的 43.8%。在没有 PTH 下降>70%的 49 例患者（59.8%）中，没有患者在术后一年发生持续性甲状旁腺功能减退症（P 值<0.001）。PTH 水平下降>70%的灵敏度为 100.0%（95%可信区间：85.8-100.0%），特异性为 73.1%（95%可信区间：62.5-83.7%），曲线下面积为 0.87（95%可信区间：0.79-0.94），可预测持续性甲状旁腺功能减退症的风险。
在我们的研究中，甲状腺全切除或近全切除术后 PTH 水平下降>70%是持续性甲状旁腺功能减退症的可靠预测指标，这需要在更大的队列中得到证实。
