离子钙和甲状旁腺激素作为全甲状腺切除术后甲状旁腺功能减退的预测指标。
Ionized calcium and PTH as predictors of hypoparathyroidism following total thyroidectomy.
作者信息
Sánchez-Canteli Mario, Pasarón-Canga María, Riestra-Fermández María, Gutiérrez-Buey Gala, Martínez-González Patricia, Fernández-Morais Raquel, Fernández-Pello Marta Elena, Álvarez-Méndez Juan Carlos
机构信息
Department of Otolaryngology, Hospital Universitario de Cabueñes, Los Prados 395, 33394, Gijón, Asturias, Spain.
Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011, Oviedo, Spain.
出版信息
Eur Arch Otorhinolaryngol. 2025 Jun;282(6):3163-3171. doi: 10.1007/s00405-025-09205-2. Epub 2025 Jan 24.
PURPOSE
Post-surgical hypoparathyroidism (POSH) is a common complication after total thyroidectomy. This study aims to assess the accuracy of serum and ionized calcium and PTH levels on the first postoperative day (POD-1) to predict postoperative hypocalcemia (PoHC), transient hypoparathyroidism (THPT), and permanent hypoparathyroidism (PtHPT).
METHODS
Biochemical parameters and clinical variables were retrospectively analyzed in 200 patients. The optimal cut-off points were determined using ROC curve analysis. Results were correlated with analytical and clinical variables and patient outcomes.
RESULTS
PoHC incidence in POD-1 was 46%; THPT and PtHPT were 37 and 9%, respectively. Ionized calcium < 4.43 mg/dL on POD-1 predicted PoHC (AUC = 0.9) better than PTH and serum calcium. PTH < 8.06 pg/mL on POD-1 predicted PtHPT (AUC = 0.797). Multivariate analysis identified PTH < 21.2 pg/mL, ionized calcium < 4.43 mg/dL, and serum calcium < 8.76 mg/dL on POD-1 as significant PoHC risk factors.
CONCLUSION
Ionized calcium on POD-1 predicts PoHC accurately, while serum PTH indicates higher risk for PtHPT.
目的
术后甲状旁腺功能减退症（POSH）是全甲状腺切除术后常见的并发症。本研究旨在评估术后第1天（POD-1）血清和离子钙及甲状旁腺激素（PTH）水平预测术后低钙血症（PoHC）、暂时性甲状旁腺功能减退症（THPT）和永久性甲状旁腺功能减退症（PtHPT）的准确性。
方法
对200例患者的生化参数和临床变量进行回顾性分析。使用ROC曲线分析确定最佳截断点。结果与分析和临床变量及患者预后相关。
结果
POD-1时PoHC的发生率为46%；THPT和PtHPT的发生率分别为37%和9%。POD-1时离子钙<4.43mg/dL预测PoHC（AUC=0.9）优于PTH和血清钙。POD-1时PTH<8.06pg/mL预测PtHPT（AUC=0.797）。多因素分析确定POD-1时PTH<21.2pg/mL、离子钙<4.43mg/dL和血清钙<8.76mg/dL是PoHC的重要危险因素。
结论
POD-1时的离子钙能准确预测PoHC，而血清PTH提示PtHPT的风险较高。
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