Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Translational Medicine in Surgery, Jilin Provincial Engineering, Laboratory of Thyroid Disease Prevention and Treatment, 126 Xiantai Street, Changchun, 130033, China.
Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.
Sci Rep. 2024 Nov 26;14(1):29310. doi: 10.1038/s41598-024-81012-x.
Hypocalcemia is a common complication of thyroidectomy, particularly total thyroidectomy. The higher incidence of hypocalcemia following total thyroidectomy is primarily due to inadvertent damage to the parathyroid glands during surgery. This study aims to investigate the predictive value of intraoperative parathyroid hormone (IOPTH) in determining hypocalcemia during hospitalization and the recovery of parathyroid function after total thyroidectomy, as well as the factors that may influence IOPTH. In this retrospective study, we analyzed a cohort of 164 patients who underwent total thyroidectomy at our institution between 2018 and 2019. IOPTH was measured either 15 min after bilateral thyroidectomy combined with area VI lymph node dissection, or 15 min after bilateral thyroidectomy alone. We plotted ROC curves for IOPTH and ΔPTH% in relation to hypocalcemia during hospitalization and recovery of parathyroid function. Additionally, we explored risk factors for the development of hypocalcemia during hospitalization and factors that may influence IOPTH. IOPTH and ΔPTH% demonstrated good specificity and sensitivity for predicting hypocalcemia during hospitalization and for assessing recovery of parathyroid function. Lower preoperative PTH levels, chronic lymphocytic thyroiditis, and intraoperative parathyroid auto-transplantation were identified as risk factors for IOPTH < 15 pg/mL. IOPTH and ΔPTH% are predictive of hypocalcemia during the postoperative hospital stay and recovery of parathyroid function. Patients with chronic lymphocytic thyroiditis, intraoperative parathyroid auto-transplantation, and low preoperative PTH levels should be closely monitored for the recovery of parathyroid function after surgery.
低钙血症是甲状腺切除术的常见并发症，尤其是全甲状腺切除术。全甲状腺切除术后低钙血症发生率较高，主要是由于手术中甲状旁腺的意外损伤。本研究旨在探讨术中甲状旁腺激素（IOPTH）在预测住院期间低钙血症和全甲状腺切除术后甲状旁腺功能恢复中的预测价值，以及可能影响 IOPTH 的因素。在这项回顾性研究中，我们分析了 2018 年至 2019 年在我们机构接受全甲状腺切除术的 164 例患者的队列。IOPTH 是在双侧甲状腺切除术联合 VI 区淋巴结清扫术完成后 15 分钟或双侧甲状腺切除术完成后 15 分钟测量的。我们绘制了 IOPTH 和 ΔPTH%与住院期间低钙血症和甲状旁腺功能恢复的 ROC 曲线。此外，我们还探讨了住院期间低钙血症发生的危险因素以及可能影响 IOPTH 的因素。IOPTH 和 ΔPTH% 对预测住院期间低钙血症和评估甲状旁腺功能恢复具有良好的特异性和敏感性。术前甲状旁腺激素（PTH）水平较低、慢性淋巴细胞性甲状腺炎和术中甲状旁腺自体移植被确定为 IOPTH <15pg/mL 的危险因素。IOPTH 和 ΔPTH% 可预测术后住院期间低钙血症和甲状旁腺功能恢复。慢性淋巴细胞性甲状腺炎、术中甲状旁腺自体移植和术前 PTH 水平较低的患者术后应密切监测甲状旁腺功能的恢复情况。
