Abdullah Abdullah Saeed
Department of Surgery, College of Medicine, University of Duhok, Azadi Teaching Hospital & Duhok Kidney Dis. Center, Duhok, Kurdistan Region, Iraq.
Ann Med Surg (Lond). 2021 Mar 29;65:102252. doi: 10.1016/j.amsu.2021.102252. eCollection 2021 May.
Estimation of parathyroid hormone (PTH) after thyroid surgery helps to predict the development of hypocalcemia and allows early intervention and management with oral calcium and/or vitamin D supplementation in the postoperative period.
This retrospective study included 57 patients who underwent total or completion thyroidectomy within 4 years. Measurement of serum PTH level was done 3 h after surgery for its change and prediction of hypocalcemia.
The mean age was 42.11 years, females constituted 46 patients (80.7%), the main surgical procedure was total thyroidectomy in 51 patients (89.5%), and the main cause for surgery was multinodular goiter in 33 patients (57.8%). Three hours after surgery 47 patients (82.5%) had serum PTH levels of >10 pg/ml (mean 28.06) and 44 patients (77.2%) had normal serum calcium (mean 8.66). Most of these 47 patients (82.46%) didn't require postoperative supplementation, while from other 10 patients (17.5%) with serum PTH level of <10 pg/ml, 7 patients (12.28%) required both oral calcium and vitamin D, and 3 patients (5.26%) required only oral vitamin D.There was a significant correlation between the 3-h postoperative PTH level and hypocalcemia (P-value 0.000). The type of pathology had no significant association with lowserum PTH level after surgery (P-value 0.166).
PTH measurements at 3 h after total thyroidectomy is an accurate predictor for the development of hypocalcemia and allows starting early calcium and/or vitamin D supplements for the asymptotic patients with PTH level of less than 10 pg/ml, which is considered a high-risk group. Also it facilitates a safe and early (2nd day post operative) discharge of those patients with serum PTH levels greater than 10 pg/ml without any supplements.Further studies are needed to compare the result of early serum PTH level with the day one serum PTH level after total thyroidectomy to predict hypocalcemia.
甲状腺手术后甲状旁腺激素（PTH）的评估有助于预测低钙血症的发生，并能在术后早期通过口服钙剂和/或补充维生素D进行干预和管理。
这项回顾性研究纳入了57例在4年内接受全甲状腺切除术或甲状腺次全切除术的患者。术后3小时测量血清PTH水平，以观察其变化并预测低钙血症。
患者平均年龄为42.11岁，女性46例（80.7%），主要手术方式为全甲状腺切除术51例（89.5%），手术主要原因是结节性甲状腺肿33例（57.8%）。术后3小时，47例（82.5%）患者血清PTH水平>10 pg/ml（平均28.06），44例（77.2%）患者血清钙正常（平均8.66）。这47例患者中大多数（82.46%）术后无需补充钙剂，而另外10例血清PTH水平<10 pg/ml的患者中，7例（12.28%）需要口服钙剂和维生素D，3例（5.26%）仅需口服维生素D。术后3小时PTH水平与低钙血症之间存在显著相关性（P值0.000）。病理类型与术后低血清PTH水平无显著相关性（P值0.166）。
全甲状腺切除术后3小时测量PTH是低钙血症发生的准确预测指标，对于PTH水平低于10 pg/ml的无症状患者，可早期开始补充钙剂和/或维生素D，此类患者被视为高危人群。对于血清PTH水平高于10 pg/ml且无需补充任何钙剂的患者，这也有助于其在术后第二天安全、早期出院。需要进一步研究比较全甲状腺切除术后早期血清PTH水平与术后第一天血清PTH水平，以预测低钙血症。
