Bai Xiaojun, Xu Yanjun, Liu Yilun
Altern Ther Health Med. 2025 Jul;31(4):162-168.
This study aims to investigate the influencing factors of transient hypoparathyroidism following thyroidectomy and assess the effects of rehabilitation treatment, focusing on enhancing management and outcomes for patients.
In this retrospective study, 90 patients who underwent thyroidectomy in our hospital from February 2021 to February 2023 were collected. According to the postoperative level of parathyroid hormone (PTH), the patients were divided into normal group [(no hypoparathyroidism, ≥ 0.27 pmol/l), n=65] and hypoparathyroidism (transient hypoparathyroidism, < 0.27 pmol/l, n=25). We retrospectively analyzed 90 thyroidectomy patients, categorizing them into normal and hypoparathyroidism groups based on postoperative parathyroid hormone levels. Logistic regression and ROC curve analysis were employed to evaluate the factors influencing transient hypoparathyroidism and predict recovery.Clinical data of the two groups of patients were collected, and the relationship between postoperative 1dPTH (Parathyroid hormone levels on the first postoperative day) level and recovery effect was analyzed. Logistic regression was used to analyze the influencing factors of temporary hypoparathyroidism after thyroidectomy, and a ROC curve was used to predict the efficacy of the 1dPTH level on postoperative PTH recovery time.
There were no differences in gender, hypertension, diabetes and hyperlipidemia between the two groups (P > .05). The age and tumor diameter of the normal group were lower than those of the hypoactive group, and the proportion of patients with thyroiditis and malignant tumors, as well as patients undergoing total thyroidectomy and removal of tracheoesophageal lymph nodes in the normal group were significantly lower than those in the hypoactive group. The above differences were statistically significant (P < .05). Logistic regression analysis showed that older age, malignant tumor, larger tumor diameter, total thyroidectomy, and tracheoesophageal lymph node dissection were independent risk factors for transient hypoparathyroidism after thyroidectomy (P < .05). The level of PTH on the 1st day after surgery in patients with recovery time ≤ 1 month was higher than that in patients with recovery time > 1 month, and the difference was statistically significant (P < .05). ROC curve showed that the PTH level on the 1st day after surgery had a certain predictive value on PTH recovery time, and the AUC value (area under the curve) was 0.873 (P < .05). These findings suggest that patients with older age, malignancy, larger tumor diameter, total thyroidectomy, and removal of tracheoesophageal lymph nodes are more likely to develop transient hypoparathyroidism after thyroidectomy. This understanding is crucial for the management of postoperative patients, and physicians may need to pay special attention to these high-risk patients and implement appropriate interventions to reduce the occurrence of hypoparathyroidism. Significant factors contributing to transient hypoparathyroidism included older age, malignant tumors, larger tumor diameter, total thyroidectomy, and tracheoesophageal lymph node dissection. These findings, backed by statistical significance, underline the clinical relevance of these risk factors in postoperative management.
The study identifies key risk factors for transient hypoparathyroidism post-thyroidectomy, emphasizing the need for tailored postoperative care. The predictive value of immediate postoperative PTH levels could guide clinical management to mitigate hypoparathyroidism risks.
本研究旨在探讨甲状腺切除术后短暂性甲状旁腺功能减退的影响因素，并评估康复治疗的效果，以加强对患者的管理并改善预后。
在这项回顾性研究中，收集了2021年2月至2023年2月在我院接受甲状腺切除术的90例患者。根据术后甲状旁腺激素（PTH）水平，将患者分为正常组[（无甲状旁腺功能减退，≥0.27 pmol/l），n = 65]和甲状旁腺功能减退组（短暂性甲状旁腺功能减退，<0.27 pmol/l，n = 25）。我们对90例甲状腺切除患者进行回顾性分析，根据术后甲状旁腺激素水平将他们分为正常组和甲状旁腺功能减退组。采用逻辑回归和ROC曲线分析来评估影响短暂性甲状旁腺功能减退的因素并预测恢复情况。收集两组患者的临床资料，分析术后第1天PTH（术后第1天甲状旁腺激素水平）水平与恢复效果之间的关系。采用逻辑回归分析甲状腺切除术后暂时性甲状旁腺功能减退的影响因素，并用ROC曲线预测术后第1天PTH水平对PTH恢复时间的疗效。
两组患者在性别、高血压、糖尿病和高脂血症方面无差异（P>.05）。正常组患者的年龄和肿瘤直径低于甲状旁腺功能减退组，正常组中甲状腺炎和恶性肿瘤患者的比例以及接受全甲状腺切除术和气管食管淋巴结清扫术的患者比例均显著低于甲状旁腺功能减退组。上述差异具有统计学意义（P<.05）。逻辑回归分析显示，年龄较大、恶性肿瘤、肿瘤直径较大、全甲状腺切除术和气管食管淋巴结清扫术是甲状腺切除术后短暂性甲状旁腺功能减退的独立危险因素（P<.05）。恢复时间≤1个月的患者术后第1天的PTH水平高于恢复时间>1个月的患者，差异具有统计学意义（P<.05）。ROC曲线显示，术后第1天的PTH水平对PTH恢复时间具有一定的预测价值，AUC值（曲线下面积）为0.873（P<.05）。这些结果表明，年龄较大、患有恶性肿瘤、肿瘤直径较大、接受全甲状腺切除术和气管食管淋巴结清扫术的患者在甲状腺切除术后更易发生短暂性甲状旁腺功能减退。这一认识对术后患者的管理至关重要,医生可能需要特别关注这些高危患者并采取适当干预措施以减少甲状旁腺功能减退的发生。导致短暂性甲状旁腺功能减退的重要因素包括年龄较大、恶性肿瘤、肿瘤直径较大、全甲状腺切除术和气管食管淋巴结清扫术。这些具有统计学意义的结果强调了这些危险因素在术后管理中的临床相关性。
本研究确定了甲状腺切除术后短暂性甲状旁腺功能减退的关键危险因素，强调了术后个性化护理的必要性。术后即刻PTH水平的预测价值可指导临床管理以降低甲状旁腺功能减退的风险。
