Dughiero Silvia, Torresan Francesca, Censi Simona, Mian Caterina, Carrillo Lizarazo José Luis, Iacobone Maurizio
Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, 35128 Padova, Italy.
Unit of Endocrinology, Department of Medicine, University of Padua, 35128 Padova, Italy.
Cancers (Basel). 2024 Aug 17;16(16):2867. doi: 10.3390/cancers16162867.
Postoperative hypoparathyroidism (HypoPTH) is the most common complication following total thyroidectomy. Several risk factors have been identified, but data on postoperative follow-up are scarce.
The study focused on 1965 patients undergoing surgery for benign and malignant thyroid diseases at a tertiary-level academic center. Anamnestic, biochemical, surgical, pathological, and follow-up data were evaluated. HypoPTH was defined by a serum concentration of PTH < 10 pg/mL on the first or the second post-operative day. Persistent HypoPTH was defined by the need for calcium/active vitamin D treatment > 12 months after surgery.
Postoperative HypoPTH occurred in 542 patients. Multivariate analysis identified the association of central lymph-nodal dissection, reduced preoperative PTH levels, a lower rate of parathyroid glands preserved in situ, and longer duration of surgery as independent risk factors. At a median follow-up of 47 months, HypoPTH regressed in 443 patients (more than 6 months after surgery in 7%) and persisted in 53 patients. Patients receiving a lower dose of calcium/active vitamin D treatment at discharge (HR 0.559; < 0.001) or undergoing prolonged, tailored, and direct follow-up by the operating endocrine surgeon team had a significantly lower risk of persistent HypoPTH (2.4% compared to 32.8% for other specialists) (HR 2.563; < 0.001).
Various patient, disease, and surgeon-related risk factors may predict postoperative HypoPTH. Lower postoperative calcium/active vitamin D treatment and prolonged, tailored follow-up directly performed by operating endocrine surgeons may significantly reduce the rate of persistent HypoPTH.
术后甲状旁腺功能减退（HypoPTH）是全甲状腺切除术后最常见的并发症。已确定了几个风险因素，但术后随访数据稀缺。
该研究聚焦于一家三级学术中心的1965例接受甲状腺良恶性疾病手术的患者。对既往史、生化、手术、病理及随访数据进行评估。HypoPTH定义为术后第一天或第二天血清甲状旁腺激素（PTH）浓度<10 pg/mL。持续性HypoPTH定义为术后>12个月仍需要钙/活性维生素D治疗。
542例患者发生术后HypoPTH。多因素分析确定中央淋巴结清扫、术前PTH水平降低、原位保留甲状旁腺的比例较低以及手术时间较长为独立风险因素。中位随访47个月时，443例患者的HypoPTH症状消退（7%在术后超过6个月），53例患者持续存在。出院时接受较低剂量钙/活性维生素D治疗的患者（风险比[HR]0.559；P<0.001）或由手术内分泌外科医生团队进行长期、针对性和直接随访的患者发生持续性HypoPTH的风险显著较低（2.4%，而其他专科医生为32.8%）（HR 2.563；P<0.001）。
多种患者、疾病和外科医生相关的风险因素可能预测术后HypoPTH。术后较低剂量的钙/活性维生素D治疗以及手术内分泌外科医生直接进行的长期、针对性随访可能显著降低持续性HypoPTH的发生率。
