Hao Qing, Qin Yun, Zhao Wanjun, Zhang Lingyun, Luo Han
Department of Thyroid and Parathyroid Surgery, Laboratory of thyroid and parathyroid disease, Frontiers Science Center for Disease-related Molecular Network, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
Front Pharmacol. 2021 Mar 8;12:626614. doi: 10.3389/fphar.2021.626614. eCollection 2021.
In postthyroidectomy patients, hypocalcemia is the most common complication to prolong hospital stay and decrease patients' satisfaction. Based on current evidence, it is recommended to supply vitamin D to patients with high risk of developing hypocalcemia. However, how to stratify the risk of patients remains challenging. We conducted a prospective study to evaluate the effect of vitamin D supplement (calcitriol) on high-risk hypocalcemia patients based on relative decline of parathyroid hormone (RDP). RDP was calculated by the difference between preoperative and postoperative first-day PTH divided by preoperative PTH and presented as percentage. Patients who underwent total thyroidectomy in addition to bilateral central compartment dissection were enrolled prospectively and were divided into two cohorts: Cohort I: patients with RDP ≤70% and Cohort II: patients with RDP >70%. Patients in Cohort I were then randomly assigned to Group A or B, and patients in Cohort II were randomly assigned to Group C or D. All groups received oral calcium, and patients in Groups B and D also received calcitriol. All patients were followed for one year. In the study, standard procedure dictates that only oral calcium is given to patients whose RDP ≤70% and that oral calcium and calcitriol are given to patients whose RDP >70%. Therefore, Cohort I Group A and Cohort II Group D are controls in this study. The incidence of clinical hypocalcemia in Groups A and D (the controls) was 11.0% (10/91), and 17.6% (16/91) required additional intravenous calcium. Of note, no patients developed permanent hypocalcemia. Furthermore, calcitriol supplement did not have significant impact on clinical outcomes between Group A and B in Cohort I. By contrast, calcitriol supplement distinctly improved clinical outcome by comparing Groups C and D (Cohort II), as marked by clinical hypocalcemia, need of requiring intravenous calcium, and long-termed decreased levels of PTH. Supplying calcitriol based on RDP cutoff of 70% may be a wise practice in thyroidectomy patients, and RDP 70% may be a useful predictor to stratify high-risk patients.
在甲状腺切除术后患者中，低钙血症是延长住院时间并降低患者满意度的最常见并发症。基于现有证据，建议对有发生低钙血症高风险的患者补充维生素D。然而，如何对患者的风险进行分层仍然具有挑战性。我们进行了一项前瞻性研究，以基于甲状旁腺激素相对下降率（RDP）评估维生素D补充剂（骨化三醇）对高风险低钙血症患者的影响。RDP通过术前和术后第一天甲状旁腺激素（PTH）的差值除以术前PTH来计算，并以百分比表示。前瞻性纳入接受全甲状腺切除术加双侧中央区淋巴结清扫术的患者，并将其分为两个队列：队列I：RDP≤70%的患者；队列II：RDP>70%的患者。然后将队列I中的患者随机分配到A组或B组，将队列II中的患者随机分配到C组或D组。所有组均接受口服钙剂，B组和D组的患者还接受骨化三醇治疗。所有患者均随访一年。在该研究中，标准程序规定，RDP≤70%的患者仅给予口服钙剂，RDP>70%的患者给予口服钙剂和骨化三醇。因此，队列I的A组和队列II的D组是本研究中的对照组。A组和D组（对照组）的临床低钙血症发生率分别为11.0%（10/91），17.6%（16/91）的患者需要额外静脉补钙。值得注意的是，没有患者发生永久性低钙血症。此外，在队列I中，补充骨化三醇对A组和B组的临床结局没有显著影响。相比之下，通过比较C组和D组（队列II），补充骨化三醇明显改善了临床结局，表现为临床低钙血症、需要静脉补钙以及长期PTH水平降低。基于70%的RDP临界值补充骨化三醇可能是甲状腺切除患者的明智做法，RDP 70%可能是分层高风险患者的有用预测指标。
