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

Yıl 2019, Cilt: 3 Sayı: 1, 21 - 26, 25.04.2019
https://doi.org/10.30565/medalanya.384037

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. 

Kaynakça

  • 1. Delbridge L. Total thyroidectomy: The evolution of surgical technique. ANZ J Surg 2003;73(9):761-68. PMID: 12956795
  • 2. Ureles AL, Freedman ZR. Thyroidology-reflections on twentieth century history. In: Faik SA, editor. Thyroid Disease, endocrinology, surgery, nuclear medicine and radiotherapy. 2nd ed. New York:Lippincott-Raven Publishers; 1997. p. l-14.
  • 3. Lefevre J H, Tresallet C, Leenhardt L, Jublanc C, Chigot JP, Menegaux F. Reoperatif surgery for thyroid disease. Langenbecks Arch Surg 2007;392(6):685-91. PMID: 17593385
  • 4. Assenza M, Ricci G, Romagnoli F, Binda B, Rengo M. Thyroid surgery: total and partial resection. Analysis of complications and a review of the literature. Chir Ital 2004;56(3):371-82. PMID:15287634
  • 5. Glinoer D, Andry G, Chantrain G, Samil N. Clinical aspects of early and late hypocalcaemia after thyroid surgery. Eur J Surg Oncol 2000;26(6):571-77. PMID: 11034808
  • 6. Milone A, Carditello A, Stilo F, Paparo D, Paparo T. Hypoparathyroidism risk after total thyroidectomy. Chir Ital 2004;56(5):617-20. PMID: 15553431
  • 7. Pattou F, Combemale F, Fabre S, Bruno C, Marc D, Jean LW et al. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 1998;22(7):718-24. PMID: 9606288
  • 8. Faik SA. Metabolic Complications of thyroid surgery:Hypocalcemia and hypoparathyroidism; hypocalcitonemia and hypothyroidism and hyperthyroidism. In:Faik SA, editor. Thyroid Disease, endocrinology, surgery, nuclearmedicine, andradiotherapy. 2nd ed. New York:Lippincott-Raven Publishers; 1997. p. 717-38.
  • 9. Kıhara M, Mıyauchi A, Kontani K, Yamauchi A, Yokomise H. Recovery of parathyroid function after total thyroidectomy: long-term follow-up study. ANZ J Surg 2005;75(7):532-36. PMID: 15972040
  • 10. Uruno T, Miyauchi A, Shimizu K, Tomoda C, Takamura Y, Ito Y et al. A prophylactic infusion of calcium solution reduces the risk of symptomatic hypocalcemia in patients after total thyroidectomy. World J Surg 2006;30(3):304-08. PMID: 16479342
  • 11. Bergamaschi R, Becouarn G, Ronceray J, Arnaud JP. Morbidity Of Thyroid Surgery Am J Surg 1998;176(1):71-75. PMID: 9683138
  • 12. Nahas ZS, Farrag TY, Lin FR, Belin RM, Tufano RP. A safe and cost-effective short hospital stay protocol to identify patients at low risk for the development of significant hypocalcemia after total thyroidectomy. Laryngoscope 2006;116(6):906-09. PMID: 16735895
  • 13. Wong C, Price S, Scott-Coombes D. Hypocalcaemia and Parathyroid Hormone Assay. Following Total Thyroidectomy: Predicting the Future. World J Surg 2006;30(5):825-32. PMID: 16680597
  • 14. Linda YBS, Joy B, Rebecca S, Herbert C. Postoperative parathyroid hormone testing decreases symptomatic hypocalcemia and associated emergency room visits after total thyroidectomy. Surgery 2010;148(4):841-45. PMID: 20723956
  • 15. Düren M, Giray S, Karataş A, Toygarlı H, Düren E. Total tiroidektomi sonrası gelişebilecek hipokalseminin erken tanısında hızlı parathormon ölçümü: Prospektif klinik çalışma. Ulusal Cerrahi Dergisi 2006;1(22):3-6.
  • 16. Richards ML, Bingener-Casey J, Pierce D, Strodel WE, Sirinek KR. Intraoperative parathyroid hormone assay: An accurate predictor of symptomatic hypocalcemia following thyroidectomy. Arch Surg 2003;138(6):632-36. PMID: 12799334
  • 17. Lim JP, Irvine R, Bugis S, Holmes D,Wiseman SM. Intact parathyroid hormone measurement 1 hour after thyroid surgery identifies individuals at high risk for the development of symptomatic hypocalcemia. Am J Surg 2009;197(5):648-54. PMID: 19393358
  • 18. Adams J, Andersen P, Everts E, Cohen J. Early postoperative calcium levels as predictors of hypocalcemia. Laryngoscope 1998;108(12):1829-31. PMID: 9851499
  • 19. Tartaglia F, Giuliani A, Sgueglia M, Biancari F, Juvonen T, Campana FP. Randomized study on oral administration of calcitriol to prevent symptomatic hypocalcemia after total thyroidectomy. Am J Surg 2005;190(3):424-29. PMID: 16105530

Total Tiroidektomi Sonrası Gelişebilecek Hipokalseminin Erken Tanısında Paratiroidhormon Ölçümü

Yıl 2019, Cilt: 3 Sayı: 1, 21 - 26, 25.04.2019
https://doi.org/10.30565/medalanya.384037

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. 

Kaynakça

  • 1. Delbridge L. Total thyroidectomy: The evolution of surgical technique. ANZ J Surg 2003;73(9):761-68. PMID: 12956795
  • 2. Ureles AL, Freedman ZR. Thyroidology-reflections on twentieth century history. In: Faik SA, editor. Thyroid Disease, endocrinology, surgery, nuclear medicine and radiotherapy. 2nd ed. New York:Lippincott-Raven Publishers; 1997. p. l-14.
  • 3. Lefevre J H, Tresallet C, Leenhardt L, Jublanc C, Chigot JP, Menegaux F. Reoperatif surgery for thyroid disease. Langenbecks Arch Surg 2007;392(6):685-91. PMID: 17593385
  • 4. Assenza M, Ricci G, Romagnoli F, Binda B, Rengo M. Thyroid surgery: total and partial resection. Analysis of complications and a review of the literature. Chir Ital 2004;56(3):371-82. PMID:15287634
  • 5. Glinoer D, Andry G, Chantrain G, Samil N. Clinical aspects of early and late hypocalcaemia after thyroid surgery. Eur J Surg Oncol 2000;26(6):571-77. PMID: 11034808
  • 6. Milone A, Carditello A, Stilo F, Paparo D, Paparo T. Hypoparathyroidism risk after total thyroidectomy. Chir Ital 2004;56(5):617-20. PMID: 15553431
  • 7. Pattou F, Combemale F, Fabre S, Bruno C, Marc D, Jean LW et al. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 1998;22(7):718-24. PMID: 9606288
  • 8. Faik SA. Metabolic Complications of thyroid surgery:Hypocalcemia and hypoparathyroidism; hypocalcitonemia and hypothyroidism and hyperthyroidism. In:Faik SA, editor. Thyroid Disease, endocrinology, surgery, nuclearmedicine, andradiotherapy. 2nd ed. New York:Lippincott-Raven Publishers; 1997. p. 717-38.
  • 9. Kıhara M, Mıyauchi A, Kontani K, Yamauchi A, Yokomise H. Recovery of parathyroid function after total thyroidectomy: long-term follow-up study. ANZ J Surg 2005;75(7):532-36. PMID: 15972040
  • 10. Uruno T, Miyauchi A, Shimizu K, Tomoda C, Takamura Y, Ito Y et al. A prophylactic infusion of calcium solution reduces the risk of symptomatic hypocalcemia in patients after total thyroidectomy. World J Surg 2006;30(3):304-08. PMID: 16479342
  • 11. Bergamaschi R, Becouarn G, Ronceray J, Arnaud JP. Morbidity Of Thyroid Surgery Am J Surg 1998;176(1):71-75. PMID: 9683138
  • 12. Nahas ZS, Farrag TY, Lin FR, Belin RM, Tufano RP. A safe and cost-effective short hospital stay protocol to identify patients at low risk for the development of significant hypocalcemia after total thyroidectomy. Laryngoscope 2006;116(6):906-09. PMID: 16735895
  • 13. Wong C, Price S, Scott-Coombes D. Hypocalcaemia and Parathyroid Hormone Assay. Following Total Thyroidectomy: Predicting the Future. World J Surg 2006;30(5):825-32. PMID: 16680597
  • 14. Linda YBS, Joy B, Rebecca S, Herbert C. Postoperative parathyroid hormone testing decreases symptomatic hypocalcemia and associated emergency room visits after total thyroidectomy. Surgery 2010;148(4):841-45. PMID: 20723956
  • 15. Düren M, Giray S, Karataş A, Toygarlı H, Düren E. Total tiroidektomi sonrası gelişebilecek hipokalseminin erken tanısında hızlı parathormon ölçümü: Prospektif klinik çalışma. Ulusal Cerrahi Dergisi 2006;1(22):3-6.
  • 16. Richards ML, Bingener-Casey J, Pierce D, Strodel WE, Sirinek KR. Intraoperative parathyroid hormone assay: An accurate predictor of symptomatic hypocalcemia following thyroidectomy. Arch Surg 2003;138(6):632-36. PMID: 12799334
  • 17. Lim JP, Irvine R, Bugis S, Holmes D,Wiseman SM. Intact parathyroid hormone measurement 1 hour after thyroid surgery identifies individuals at high risk for the development of symptomatic hypocalcemia. Am J Surg 2009;197(5):648-54. PMID: 19393358
  • 18. Adams J, Andersen P, Everts E, Cohen J. Early postoperative calcium levels as predictors of hypocalcemia. Laryngoscope 1998;108(12):1829-31. PMID: 9851499
  • 19. Tartaglia F, Giuliani A, Sgueglia M, Biancari F, Juvonen T, Campana FP. Randomized study on oral administration of calcitriol to prevent symptomatic hypocalcemia after total thyroidectomy. Am J Surg 2005;190(3):424-29. PMID: 16105530
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm Araştırma Makalesi
Yazarlar

Hasan Calis 0000-0003-4182-798X

Ayse Gulbin Arici Bu kişi benim

Volkan Dogru

Cumhur Arici Bu kişi benim

Yayımlanma Tarihi 25 Nisan 2019
Gönderilme Tarihi 25 Ocak 2018
Kabul Tarihi 18 Şubat 2018
Yayımlandığı Sayı Yıl 2019 Cilt: 3 Sayı: 1

Kaynak Göster

Vancouver Calis H, Arici AG, Dogru V, Arici C. Measurement Of Parathyroidhormone Level In Early Diagnosis Of Hypocalcemia After Total Thyroidectomy. Acta Med. Alanya. 2019;3(1):21-6.

9705 

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