Measurement Of Parathyroidhormone Level In Early Diagnosis Of Hypocalcemia After Total Thyroidectomy

Yıl 2019, , 21 - 26, 25.04.2019

Hasan Calis , Ayse Gulbin Arici Volkan Dogru , Cumhur Arici

https://doi.org/10.30565/medalanya.384037

Cited By: 1

Öz

Objective: Hypoparathyroidism is a major complication of thyroid surgery. Inadvertent removal of the parathyroid glands or nutritional deterioration of the parathyroid glands are the most important mechanisms that explains the reduction of postoperative parathyroid functions. In this study, postoperative parathyroid hormone (PTH) level was analyzed in order to prevent hypocalcaemia and enable the patients to be discharged safely. 

Methods: Preoperative calcium level, postoperative 20 minutes, 4 hours, 24 hours levels, 10 days and 6 months calcium level and 20 minutes, 4 hours and 24 hours PTH level and postoperative complications and histopathology results of the 85 patients who had total thyroidectomy were recorded. Patients were given calcium carbonate and/or calcitriol or they were discharged without any treatment depending on their PTH level on the postoperative 24 hours. 

Results: In our study, PTH levels analyzed on the postoperative 20 minutes, 4 hours and 24 hours were found to be statistically significant (p:0,0001) to be able to detect hypocalcaemia in an early stage. However PTH level was found to be statistically more sensitive (%91.5) on the postoperative 20 minutes. In our study, postoperative calcium levels were not found to be significant in detecting hypocalcaemia in an early stage that may develop after total thyroidectomy. 

Conclusion: We are in the opinion that with a PTH level analyzed on the 20th postoperative minute, patients can be discharged safely 24 hours after the surgery; furthermore, we also believe that in the presence of a higher level than 10 pg/ml PTH level we will not observe postoperative hypocalcaemia symptoms. 

Anahtar Kelimeler

Total thyroidectomy, hypocalcemia, parathyroid hormone, hypoparathyroidemia.

Total Tiroidektomi Sonrası Gelişebilecek Hipokalseminin Erken Tanısında Paratiroidhormon Ölçümü

Öz

Amaç: Hipoparatiroidizm, tiroid cerrahisinin önemli bir komplikasyonudur. Paratiroid bezlerinin istenmeden çıkarılması veya beslenmesinin bozulması postoperatif paratiroid fonksiyonlarının azalmasını açıklayan en önemli mekanizmalardır. Bu yazıda hastaların hipokalsemi gelişmemesi için güvenle taburcu edilebileceği postoperatif paratiroid hormon (PTH) değeri araştırıldı. 

Yöntemler: Total tiroidektomi yapılan 85 hastanın preoperatif kalsiyum değerleri, postoperatif 20. dakika, 4. saat, 24. saat, 10. gün ve 6. ay kalsiyum değerleriyle 20. dakika, 4. saat ve 24. saat PTH değerleri, ameliyat sonrası dönemde gelişen komplikasyonlar ve histopatoloji sonuçları kaydedildi. Hastalar postoperatif 24. saat PTH değerine göre kalsiyum karbonat ve/veya kalsitriol verilerek ya da hiçbir tedavi verilmeden taburcu edildiler. 

Bulgular: Çalışmamızda postoperatif 20. dakika, 4. saat ve 24. saatte ölçülen PTH değerleri hipokalseminin erken dönemde saptanması açısından istatistiksel olarak anlamlı bulundu (p:0,0001). Fakat 20. dakika PTH değeri istatistiksel olarak daha duyarlı bulundu (%91.5). Total tiroidektomi sonrası gelişebilecek hipokalseminin erken dönemde tespitinde postoperatif kalsiyum değerleri çalışmamızda anlamlı bulunmamıştır. 

Sonuç: Postoperatif 20. dakikada ölçülecek PTH değeri ile hastaların 24. saatte güvenle taburcu edilebileceğini ve 10 pg/ml’den büyük PTH değerleri varlığında postoperatif hipokalsemi semptomlarıyla karşılaşılmayacağını düşünüyoruz. 

Anahtar Kelimeler

Total tiroidektomi, hipokalsemi, paratiroid hormon, hipoparatiroidi

Kaynakça

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