儿童和成人全甲状腺切除术后甲状旁腺功能的晚期恢复：有区别吗？
Late Recovery of Parathyroid Function after Total Thyroidectomy in Children and Adults: Is There a Difference?
机构信息
Centre for Endocrine Surgery, University College London Hospitals NHS Foundation Trust and Great Ormond Street Hospital, London, United Kingdom,
Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain.
出版信息
Horm Res Paediatr. 2020;93(9-10):539-547. doi: 10.1159/000513768. Epub 2021 Mar 11.
BACKGROUND
Parathyroid failure after total thyroidectomy is the commonest adverse event amongst both children and adults. The phenomenon of late recovery of parathyroid function, especially in young patients with persistent hypoparathyroidism, is not well understood. This study investigated differences in rates of parathyroid recovery in children and adults and factors influencing this.
METHODS
A joint dual-centre database of patients who underwent a total thyroidectomy between 1998 and 2018 was searched for patients with persistent hypoparathyroidism, defined as dependence on oral calcium and vitamin D supplementation at 6 months. Demographic, surgical, pathological, and biochemical data were collected and analysed.
RESULTS
Out of 960 patients who had total thyroidectomy, 94 (9.8%) had persistent hypoparathyroidism at 6 months, 23 (24.5%) children with a median [range] age 10 [0-17], and 71 (75.5%) adults aged 55 [25-82] years, respectively. Both groups were comparable regarding sex, indication, extent of surgery, and PGRIS score. After a median follow-up of 20 months, the parathyroid recovery rate was identical for children and adults (11 [47.8%] vs. 34 [47.9%]; p = 0.92). Sex, extent, and indication for surgery had no effect on recovery (all p > 0.05). PGRIS score = 4 (HR = 0.48) and serum calcium >2.25 mmol/L (HR = 0.24) at 1 month were associated with a decreased risk of persistent hypoparathyroidism on multivariate analysis (p < 0.05).
CONCLUSION
Almost half of patients recovered from persistent hypoparathyroidism after 6 months; therefore, the term persistent instead of permanent hypoparathyroidism should be used. Recovery rates of parathyroid function in children and adults were similar. Regardless of age, predictive factors for recovery were PGRIS score = 4 and a serum calcium >2.25 mmol/L at 1 month.
背景
甲状旁腺功能减退症是儿童和成人甲状腺全切除术后最常见的不良事件。甲状旁腺功能恢复延迟的现象，特别是在持续甲状旁腺功能减退的年轻患者中，尚不清楚。本研究调查了儿童和成人甲状旁腺恢复率的差异及影响因素。
方法
对 1998 年至 2018 年间在两个中心接受甲状腺全切除术的患者进行联合数据库检索，寻找在 6 个月时依赖口服钙剂和维生素 D 补充剂的持续性甲状旁腺功能减退症患者。收集并分析患者的人口统计学、手术、病理和生化数据。计算甲状旁腺原位剩余（PGRIS）评分。
结果
在 960 例甲状腺全切除术患者中，94 例（9.8%）在 6 个月时出现持续性甲状旁腺功能减退症，其中儿童 23 例（24.5%），中位年龄为 10 岁[0-17 岁]，成人 71 例（75.5%），年龄 55 岁[25-82 岁]。两组患者的性别、适应证、手术范围和 PGRIS 评分相似。中位随访 20 个月后，儿童和成人的甲状旁腺恢复率相同（11[47.8%]例 vs. 34[47.9%]例；p=0.92）。手术的性别、范围和适应证对恢复无影响（均 p>0.05）。PGRIS 评分=4（HR=0.48）和 1 个月时血清钙>2.25mmol/L（HR=0.24）是多变量分析中持续性甲状旁腺功能减退症的危险因素（p<0.05）。
结论
6 个月后，近一半的患者甲状旁腺功能减退症得到恢复，因此，术语持续性而非永久性甲状旁腺功能减退症应该使用。儿童和成人的甲状旁腺功能恢复率相似。无论年龄大小，恢复的预测因素是 PGRIS 评分=4 和 1 个月时血清钙>2.25mmol/L。
Zotero 插件