Sekar Suganya, Belavendra Antonisamy, Jacob Paul M
Department of Endocrine and Breast Surgery, Velammal Medical College and Research Centre, Madurai, Tamil Nadu, India.
Department of Biostatistics and, Christian Medical College, Vellore, Tamil Nadu, India.
Indian J Endocrinol Metab. 2020 Jul-Aug;24(4):319-324. doi: 10.4103/ijem.IJEM_172_20. Epub 2020 Aug 27.
This study aimed to evaluate a protocol using post thyroidectomy parathyroid hormone (PTH) levels on the day after surgery to facilitate early discharge of patients.
This prospective observational study was done in Christian Medical College, India over 1 year with 125 consecutive patients who had serum PTH and calcium values measured in the morning following thyroidectomy/first postoperative day (D1). Patients with no symptoms and signs of hypocalcemia and with serum calcium ≥8 mg/dL and PTH ≥6 pg/ml according to the protocol were discharged without supplements on D1. Patients were followed up and tested for a week after surgery in the outpatient clinic to assess hypocalcemia and readmission rates.
Seventy five patients (60%) could be discharged early on D1without calcium supplementation; only one patient had mild hypocalcemia symptoms managed with oral calcium supplements during outpatient follow-up within 1 week and none who followed the protocol required readmission. Temporary biochemical hypocalcemia was encountered in 36 patients (28.8%) including symptomatic hypocalcemia in 13 patients (10.4%). Among the 36 patients with hypocalcemia, 26 patients (72.2%) had a PTH level <6 pg/ml. Three patients required intravenous calcium infusion to correct hypocalcemia. Sensitivity, specificity and positive predictive value, and ROC of PTH 6 pg/ml in predicting hypocalcemia were 70.5%, 94.5% and 83.3%, 0.86, respectively. The low PTH could also guide early supplementation of calcium and all the severe hypocalcemia patients had PTH lower than the cut off of 6 pg/ml.
A PTH and calcium-based protocol can be effectively used for early discharge of thyroidectomy patients the day after surgery without calcium supplementation. The compliance of the patient for early discharge was good.
本研究旨在评估一种方案，该方案利用甲状腺切除术后第一天的甲状旁腺激素（PTH）水平来促进患者早日出院。
这项前瞻性观察性研究在印度基督教医学院进行，为期1年，连续纳入125例患者，这些患者在甲状腺切除术后/术后第一天（D1）早晨测量了血清PTH和钙值。根据该方案，无症状和低钙血症体征且血清钙≥8mg/dL和PTH≥6pg/ml的患者在D1无需补充钙剂即可出院。患者在术后门诊随访一周，以评估低钙血症和再入院率。
75例患者（60%）可在D1早期出院而无需补充钙剂；仅1例患者在1周内门诊随访期间出现轻度低钙血症症状，经口服钙剂治疗，遵循该方案的患者均无需再次入院。36例患者（28.8%）出现暂时性生化性低钙血症，其中13例患者（10.4%）出现症状性低钙血症。在36例低钙血症患者中，26例患者（72.2%）的PTH水平<6pg/ml。3例患者需要静脉输注钙剂以纠正低钙血症。PTH 6pg/ml预测低钙血症的敏感性、特异性、阳性预测值和ROC分别为70.5%、94.5%、83.3%和0.86。低PTH水平还可指导早期补钙，所有重度低钙血症患者的PTH均低于6pg/ml的临界值。
基于PTH和钙的方案可有效用于甲状腺切除术后患者术后第一天无需补充钙剂即可早日出院。患者对早日出院的依从性良好。
