Moreno Llorente Pablo, García Barrasa Arantxa, Pascua Solé Mireia, Muñoz de Nova José Luis, Alberich Prats Marta
Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, C/ Feixa Llarga s/n, L'Hospitalet de Llobregat, Barcelona, E-0897, Spain.
Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.
Langenbecks Arch Surg. 2025 Jan 31;410(1):58. doi: 10.1007/s00423-025-03619-6.
Measurement of intraoperative intact parathyroid hormone (ioPTH) levels is a reliable predictor of postsurgical hypocalcemia. We assessed the optimal cutoff values of ioPTH decline for predicting postoperative early and permanent hypoparathyroidism.
This was a retrospective study of a prospectively maintained database of patients undergoing thyroid surgery in a tertiary care hospital in L'Hospitalet de Llobregat (Barcelona, Spain). All consecutive patients undergoing total thyroidectomy with or without central neck dissection between January 2005 and May 2021 were analyzed. The best cutoff value of the decrease of ioPTH level between PTH assessed after induction of anesthesia and at 10 min after completion of surgery for predicting hypocalcemia was evaluated.
We included 742 patients (mean age 52 years) (thyroid cancer 48%, neck dissection 42%) undergoing total thyroidectomy. Postoperative hypocalcemia was diagnosed in 383 (51.6%) patients, which was transient in 296 (39.9%) and permanent in 87 (11.7%). The optimal cutoff value for predicting transient hypocalcemia was a decline of ioPTH level of ≤ 62.5% (overall efficacy 87%), but calcium supplementation may be indicated in high-risk cutoff values of ≥ 79.9%. In patients with an ioPTH decline ≤ 39%, the probability of postoperative hypocalcemia is extremely unlikely. Patients with declines > 93.7% should be followed very closely since they are high-risk for developing permanent hypoparathyroidism.
The decline of ioPTH, measured as the difference between ioPTH before thyroidectomy and after completion of the surgical procedure is a reliable indicator of the likelihood of postoperative transient hypocalcemia, with optimal cutoff value of 62.5%.
术中完整甲状旁腺激素（ioPTH）水平的测量是术后低钙血症的可靠预测指标。我们评估了ioPTH下降的最佳临界值，以预测术后早期和永久性甲状旁腺功能减退。
这是一项对西班牙巴塞罗那略夫雷加特的一家三级护理医院前瞻性维护的甲状腺手术患者数据库进行的回顾性研究。分析了2005年1月至2021年5月期间所有连续接受全甲状腺切除术（无论是否进行中央颈清扫）的患者。评估了麻醉诱导后和手术完成后10分钟时所测PTH之间ioPTH水平下降的最佳临界值，以预测低钙血症。
我们纳入了742例接受全甲状腺切除术的患者（平均年龄52岁）（甲状腺癌患者占48%，颈清扫患者占42%）。383例（51.6%）患者被诊断为术后低钙血症，其中296例（39.9%）为暂时性，87例（11.7%）为永久性。预测暂时性低钙血症的最佳临界值是ioPTH水平下降≤62.5%（总体有效率87%），但在≥79.9%的高风险临界值时可能需要补钙。ioPTH下降≤39%的患者术后发生低钙血症的可能性极小。下降>93.7%的患者应密切随访，因为他们发生永久性甲状旁腺功能减退的风险很高。
以甲状腺切除术前和手术完成后ioPTH的差值来衡量的ioPTH下降，是术后暂时性低钙血症可能性的可靠指标，最佳临界值为62.5%。
