Singh Prashant K, Sahoo Reva S, Sinha Upasna, Mahto Mala, Jha Chandan K
Department of General Surgery, All India Institute of Medical Sciences, Patna, India.
Department of Radiology, All India Institute of Medical Sciences, Patna, India.
Am Surg. 2023 Dec;89(12):5570-5576. doi: 10.1177/00031348231161664. Epub 2023 Mar 3.
Clinical hypocalcemia (CH) following total thyroidectomy (TT) is a potentially life-threatening condition if left untreated. This study aimed at evaluating the accuracy of parathyroid hormone (PTH) measured in the early morning of the first postoperative day (POD-1) in predicting CH, and determining the cutoff values of PTH that can predict the development of CH.
We performed a retrospective review of patients undergoing TT between February 2018 and July 2022. Serum PTH, calcium, and albumin levels were measured on morning (6-8 AM) of postoperative day one (POD-1), and serum calcium level was measured from POD-2 onwards. We performed ROC curve analysis to determine the accuracy of PTH in predicting postoperative CH, and cutoff values of PTH to predict CH.
Ninety-one patients, 52 (57.1%) with benign and 39 (42.9%) with malignant goiter were included. The incidence of biochemical, and clinical hypocalcemia was 24.2% and 30.8%, respectively. In our study serum, PTH measured in the early morning of first postoperative day following TT was found to have good accuracy (AUC = .88) in predicting CH. A PTH value of ≥27.15 pg/mL was found to have a 96.4% sensitivity in ruling out CH, while a serum PTH value <10.65 pg/mL had a specificity of 95.2% in predicting CH.
Patients with a serum PTH value of ≥27.15 pg/mL can be discharged without any supplements, those with PTH <10.65 pg/mL should be started on calcium and calcitriol supplements, while patients having PTH values between 10.65 and 27.15 pg/mL should be monitored for the development of signs and/or symptoms of hypocalcemia.
全甲状腺切除术后的临床低钙血症（CH）若不治疗，可能会危及生命。本研究旨在评估术后第一天清晨（POD-1）测得的甲状旁腺激素（PTH）预测CH的准确性，并确定可预测CH发生的PTH临界值。
我们对2018年2月至2022年7月期间接受全甲状腺切除术的患者进行了回顾性研究。在术后第一天清晨（6-8点）测量血清PTH、钙和白蛋白水平，从术后第二天开始测量血清钙水平。我们进行ROC曲线分析以确定PTH预测术后CH的准确性以及预测CH的PTH临界值。
纳入91例患者，其中52例（57.1%）为良性甲状腺肿，39例（42.9%）为恶性甲状腺肿。生化性低钙血症和临床低钙血症的发生率分别为24.2%和30.8%。在我们的研究中，发现全甲状腺切除术后第一天清晨测得的血清PTH在预测CH方面具有良好的准确性（AUC = 0.88）。发现PTH值≥27.15 pg/mL在排除CH方面具有96.4%的敏感性，而血清PTH值<10.65 pg/mL在预测CH方面具有95.2%的特异性。
血清PTH值≥27.15 pg/mL的患者无需补充任何物质即可出院，PTH<10.65 pg/mL的患者应开始补充钙和骨化三醇，而PTH值在10.65至27.15 pg/mL之间的患者应监测是否出现低钙血症的体征和/或症状。
