From the Division of Breast & Thyroid Surgical Oncology, Department of Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Gyeonggi-do, Republic of Korea.
From the Division of Breast & Thyroid Surgical Oncology, Department of Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Gyeonggi-do, Republic of Korea..
Endocr Pract. 2020 Jul;26(7):768-776. doi: 10.4158/EP-2019-0544. Epub 2020 Nov 24.
This study aimed to investigate the incidence rates, risk factors, and clinical implications of delayed hypoparathyroidism on postoperative day 2 (POD-2) after total thyroidectomy in patients with papillary thyroid carcinoma.
This study included 410 patients with normal serum intact parathyroid hormone (iPTH) and calcium levels on postoperative day 1 (POD-1) who were classified into 2 groups according to the presence or absence of delayed hypoparathyroidism on POD-2.
Of the 410 patients, 98 experienced delayed hypoparathyroidism on POD-2 (23.9%). The significant risk factors for delayed hypoparathyroidism on POD-2 included female gender, age older than 45 years, central lymph node dissection, increased number of excised lymph nodes, and low POD-1 versus preoperative iPTH ratios. Additionally, delayed hypoparathyroidism on POD-2 was found to be a significant risk factor for hypocalcemia on POD-2 and permanent hypoparathyroidism.
Prophylactic calcium supplementation and long-term surveillance for permanent hypoparathyroidism should be considered in patients with risk factors for delayed hypoparathyroidism on POD-2.
CI = confidence interval; iPTH = intact parathyroid hormone; OR = odds ratio; POD-1 = postoperative day 1; POD-2 = postoperative day 2; PTC = papillary thyroid carcinoma; ROC = receiver operating characteristic.
本研究旨在探讨甲状腺癌患者全甲状腺切除术后第 2 天（POD-2）发生延迟性甲状旁腺功能减退症的发生率、危险因素及其临床意义。
本研究纳入了 410 例术后第 1 天（POD-1）血清完整甲状旁腺激素（iPTH）和钙水平正常的患者，根据术后第 2 天（POD-2）是否存在延迟性甲状旁腺功能减退症，将其分为 2 组。
410 例患者中，98 例（23.9%）在 POD-2 发生延迟性甲状旁腺功能减退症。POD-2 发生延迟性甲状旁腺功能减退症的显著危险因素包括女性、年龄>45 岁、中央淋巴结清扫术、切除淋巴结数量增加、POD-1 与术前 iPTH 比值降低。此外，POD-2 发生延迟性甲状旁腺功能减退症是 POD-2 低钙血症和永久性甲状旁腺功能减退症的显著危险因素。
对于有 POD-2 发生延迟性甲状旁腺功能减退症风险的患者，应考虑预防性补钙和长期监测永久性甲状旁腺功能减退症。
CI = 置信区间；iPTH = 完整甲状旁腺激素；OR = 比值比；POD-1 = 术后第 1 天；POD-2 = 术后第 2 天；PTC = 甲状腺乳头状癌；ROC = 接受者操作特征。
