Kördel Carl, Koman Anna, Bränström Robert, Stenman Adam
Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden and Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden.
Thyroid Res. 2022 Mar 19;15(1):5. doi: 10.1186/s13044-022-00123-7.
Hypocalcemia is one of the most common complications of thyroidectomy, and vitamin D deficiency has been found to be an independent risk factor. Sweden is located north of the 55th latitude, resulting in a significant seasonal variation in sun exposure, thereby large variation in the naturally occurring levels of vitamin D. This study aimed to determine if there is a correlation between season of surgery and post-thyroidectomy hypocalcemia.
We conducted a retrospective register-based observation study on patients who had undergone total thyroidectomy during 2008-2015. In total, 7125 patients operated in Swedish facilities were identified via the Scandinavian Quality Register for Thyroid, Parathyroid, and Adrenal Surgery (SQRTPA). Patients operated during February-April were included in the dark group and patients operated during August-October were included in the bright group. Further stratification was made on the indication for surgery. The primary outcome was post-operative calcium treatment due to hypocalcemia, defined as having received calcium orally or intravenously before discharge.
The risk of receiving post-operative calcium treatment was significantly lower in the bright group (29.7%) compared to the dark group (35.1%), with a relative risk of 0.846 (P < 0.001). This correlation held true if the indication for surgery was goiter or thyrotoxicosis. For malignancy, there was no significant difference between the groups.
In this cohort, total thyroidectomy performed during August-October was associated with a lower rate of calcium treatment given post-operatively when compared to total thyroidectomy performed during February-April. This would indicate a decreased risk of post-operative hypocalcemia if surgery was carried out after the brighter season.
低钙血症是甲状腺切除术后最常见的并发症之一，维生素D缺乏已被发现是一个独立的危险因素。瑞典位于北纬55度以北，导致日照有显著的季节性变化，从而使维生素D的自然生成水平有很大差异。本研究旨在确定手术季节与甲状腺切除术后低钙血症之间是否存在相关性。
我们对2008年至2015年期间接受全甲状腺切除术的患者进行了一项基于登记的回顾性观察研究。通过斯堪的纳维亚甲状腺、甲状旁腺和肾上腺手术质量登记处（SQRTPA），总共确定了7125名在瑞典医疗机构接受手术的患者。2月至4月接受手术的患者被纳入“黑暗组”，8月至10月接受手术的患者被纳入“明亮组”。根据手术指征进行了进一步分层。主要结局是因低钙血症而进行的术后补钙治疗，定义为出院前接受了口服或静脉补钙。
与“黑暗组”（35.1%）相比，“明亮组”接受术后补钙治疗的风险显著较低，相对风险为0.846（P < 0.001）。如果手术指征是甲状腺肿或甲状腺毒症，这种相关性仍然成立。对于恶性肿瘤，两组之间没有显著差异。
在这个队列中，与2月至4月进行的全甲状腺切除术相比，8月至10月进行的全甲状腺切除术术后补钙率较低。这表明如果在日照更充足的季节之后进行手术，术后低钙血症的风险会降低。
