术后第 1 天甲状旁腺激素水平对甲状腺切除术后早期和晚期低钙血症的预测价值。
Predictive value of postoperative day 1 parathyroid hormone levels for early and late hypocalcaemia after thyroidectomy.
机构信息
Dept Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.
Dept Endocrinology, South Infirmary Victoria University Hospital, Cork, Ireland.
出版信息
Langenbecks Arch Surg. 2022 Jun;407(4):1653-1658. doi: 10.1007/s00423-022-02480-1. Epub 2022 Mar 5.
PURPOSE
Early parathyroid hormone (PTH) levels after total thyroidectomy can predict patients at low risk of hypocalcaemia who can be discharged early without calcium supplementation. For centres without facility to perform early PTH levels, PTH levels sent on the first postoperative day (POD1) may be an alternative. However, there is less data regarding optimal cut-off PTH levels for POD1 discharge.
METHODS
Retrospective review of prospective database of thyroid operations between September 2009 and February 2020 at tertiary referral centre. Main outcome measure was symptomatic hypocalcaemia.
RESULTS
Five hundred seventy patients undergoing total (521) or completion thyroidectomy with POD1 PTH levels available were included. Among patients with POD1 PTH levels ≥ 20 pg/ml and POD1 calcium ≥ 2.0 mmol/l, the incidence of symptomatic hypocalcaemia was 1% (3/300), and need for intravenous calcium 0.3% (1/300). For POD1 PTH levels 15-19 pg/ml and POD1 calcium ≥ 2.0 mmol/l, the incidence of symptomatic hypocalcaemia and need for intravenous calcium was 5.4% (3/55). For PTH levels 10-14 pg/ml and calcium ≥ 2.0 mmol/l, the incidence of symptomatic hypocalcaemia and need for intravenous calcium was 11.7% (7/60). The risk of permanent hypoparathyroidism was < 1% for POD1 PTH levels ≥ 15 pg/ml; 5.4% for levels 10-14 pg/ml; and 19.8% for levels < 10 pg/ml.
CONCLUSIONS
POD1 PTH levels ≥ 15 pg/ml along with calcium ≥ 2.0 mmol/l are associated with low risk of symptomatic hypocalcaemia, and represent a safe criterion for discharge of most patients without calcium supplementation. For certain patient groups, a higher threshold of 20 pg/ml could be considered.
目的
全甲状腺切除术后早期甲状旁腺激素（PTH）水平可预测低钙血症风险低的患者，这些患者无需补钙即可提前出院。对于没有条件检测早期 PTH 水平的中心，术后第 1 天（POD1）的 PTH 水平可能是另一种选择。然而，关于 POD1 出院的最佳 PTH 水平截止值的数据较少。
方法
回顾性分析 2009 年 9 月至 2020 年 2 月期间在三级转诊中心进行的甲状腺手术的前瞻性数据库。主要观察指标为症状性低钙血症。
结果
共纳入 570 例接受全甲状腺切除术（521 例）或完成性甲状腺切除术且 POD1 有 PTH 水平的患者。在 POD1 PTH 水平≥20 pg/ml 和 POD1 钙≥2.0 mmol/l 的患者中，症状性低钙血症的发生率为 1%（3/300），需要静脉补钙的比例为 0.3%（1/300）。对于 POD1 PTH 水平 15-19 pg/ml 和 POD1 钙≥2.0 mmol/l 的患者，症状性低钙血症和需要静脉补钙的比例为 5.4%（3/55）。对于 PTH 水平 10-14 pg/ml 和钙≥2.0 mmol/l 的患者，症状性低钙血症和需要静脉补钙的比例为 11.7%（7/60）。POD1 PTH 水平≥15 pg/ml 时，永久性甲状旁腺功能减退的风险<1%；PTH 水平 10-14 pg/ml 时为 5.4%；PTH 水平<10 pg/ml 时为 19.8%。
结论
POD1 PTH 水平≥15 pg/ml 同时钙≥2.0 mmol/l 与症状性低钙血症风险低相关，代表无需补钙即可安全出院的大多数患者的标准。对于某些患者群体，可以考虑更高的 20 pg/ml 阈值。
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