Guglielmetti Laura, Schmidt Sina, Busch Mirjam, Wagner Joachim, Naddaf Ali, Leitner Barbara, Harsch Simone, Zielke Andreas, Smaxwil Constantin
Department of Surgery, Kantonsspital Winterthur, 8400 Winterthur, Switzerland.
Department of Endocrine Surgery, Endocrine Center Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany.
J Clin Med. 2022 Jun 3;11(11):3202. doi: 10.3390/jcm11113202.
Background: Postsurgical hypoparathyroidism (PH) is the most common side effect of bilateral thyroid resections. Data regarding the time course of recovery from PH are currently unavailable. Therefore, a detailed analysis of the time course of PH recovery and conditions associated with rapid recovery was conducted. Methods: This is a retrospective analysis of prospectively documented data. Patients with biochemical signs of PH or need for calcium supplementation were followed-up for 12 months. Logistic regression analyses were used to identify covariates of early as opposed to late recovery from PH. Results: There were 1097 thyroid resections performed from 06/2015 to 07/2016 with n = 143 PH. Median recovery time was 8 weeks and six patients (1.1% of total thyroid resections) required calcium supplementation > 12 months. Recovery of PH within 4 and 12 weeks was characterized by high PTH levels on the first postoperative day (4 weeks: OR 1.13, 95% CI 1.06−1.20; 12 weeks: OR 1.08, 95%CI 1.01−1.16). Visualization of all PTGs emerged as an independent predictor of recovery within 12 months (OR 2.32, 95% CI 1.01−4.93) and 24 weeks (OR 2.69, 95% CI 1.08−6.69). Conclusion: In the setting of specialized high-volume endocrine surgery, permanent PH is rare. However, every second patient will require more than 2 months of continued medical surveillance. Early recovery was associated with only moderately decreased postsurgical PTH-levels. Successful late recovery appeared to be associated with the number of parathyroid glands visualized during surgery.
术后甲状旁腺功能减退（PH）是双侧甲状腺切除术后最常见的副作用。目前尚无关于PH恢复时间进程的数据。因此，对PH恢复的时间进程以及与快速恢复相关的情况进行了详细分析。方法：这是一项对前瞻性记录数据的回顾性分析。对有PH生化体征或需要补充钙的患者进行了12个月的随访。采用逻辑回归分析来确定PH早期恢复与晚期恢复的协变量。结果：2015年6月至2016年7月共进行了1097例甲状腺切除术，其中143例发生PH。中位恢复时间为8周，6例患者（占甲状腺切除术总数的1.1%）需要补充钙超过12个月。术后第1天甲状旁腺激素（PTH）水平较高是术后4周和12周内PH恢复的特征（4周：比值比[OR]1.13，95%置信区间[CI]1.06−1.20；12周：OR 1.08，95%CI 1.01−1.16）。所有甲状旁腺的可视化是12个月内（OR 2.32，95%CI 1.01−4.93）和24周内（OR 2.69，95%CI 1.08−6.69）恢复的独立预测因素。结论：在专业的大容量内分泌手术中，永久性PH很少见。然而，每两名患者中就有一名需要持续超过2个月的医学监测。早期恢复仅与术后PTH水平适度降低有关。晚期成功恢复似乎与手术中可视化的甲状旁腺数量有关。
