术中甲状旁腺激素测量有助于儿童门诊甲状腺切除术。

Intraoperative parathyroid hormone measurement facilitates outpatient thyroidectomy in children.

机构信息

University of Alabama at Birmingham Department of Surgery, Boshell Diabetes Building, 1808 7th Avenue South, Birmingham, AL 35233, USA.

出版信息

Am J Surg. 2021 Apr;221(4):683-686. doi: 10.1016/j.amjsurg.2021.02.009. Epub 2021 Feb 23.

DOI:10.1016/j.amjsurg.2021.02.009

PMID:33648715

Abstract

INTRODUCTION

We hypothesize that intraoperative parathyroid hormone (ioPTH) measurement after a total thyroidectomy predicts children at risk for hypoparathyroidism and allow for outpatient procedure.

METHODS

Between 2015 and 2019, we reviewed all patients under the age of 21 undergoing a thyroidectomy (total or lobectomy). Based on the ioPTH concentration, the patients were treated by the following protocol: a) PTH ≥20 pg/mL: no treatment; b) PTH = 10-19 pg/mL: 1000 mg calcium orally TID; c) PTH = 5-9 pg/mL: calcitriol 250 μg orally BID plus 1000 mg calcium orally TID; or d) PTH <5 pg/mL calcitriol 500 μg orally BID plus 1000 mg calcium orally TID.

RESULTS

Fifty-two patients were included with a median age of 16 (range 6-21 years). Thirty-two patients (62%) had normal PTH (≥10 pg/mL) while 20 (38%) had low PTH levels (<10 pg/mL). Of those patients with low PTH, 60% had normalization of levels within 2 weeks of surgery.

CONCLUSIONS

Thyroid surgery in children can be performed as an outpatient procedure. The ioPTH measurements and a protocol to treat patients with low PTH assists in safe discharge.

摘要

简介

我们假设，全甲状腺切除术后的甲状旁腺激素（ioPTH）测量可预测甲状旁腺功能减退症风险较高的儿童，并允许进行门诊手术。

方法

在 2015 年至 2019 年间，我们回顾了所有年龄在 21 岁以下接受甲状腺切除术（全甲状腺切除术或甲状腺叶切除术）的患者。根据 ioPTH 浓度，患者采用以下方案进行治疗：a）PTH≥20 pg/mL：无需治疗；b）PTH=10-19 pg/mL：口服 1000 mg 钙，每日 3 次；c）PTH=5-9 pg/mL：口服骨化三醇 250μg，每日 2 次，加口服 1000mg 钙，每日 3 次；或 d）PTH<5 pg/mL：口服骨化三醇 500μg，每日 2 次，加口服 1000mg 钙，每日 3 次。