The Variation of Parathyroid Hormone after Thyroidectomy and The Exploration of Influence Factors for Postthyroidectomy Hypocalcemia_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANGWei-ming , WANGHai-nan , LIHe , LIANGJie-jia , XUWei-xue ,  XUJin

Department of Pancreatic and Thyroid Surgery, Affiliated Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China;

Corresponding author：

XUJin, Email: xujinwang@163.com

Keywords：

Postthyroidectomy hypocalcemia; Parathyroid hormone; Thyroidectomy

DOI：

10.7507/1007-9424.20160377

Video：

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Objective To summarize the variation of parathyroid hormone (PTH) after thyroidectomy and the influence factors of postthyroidectomy hypocalcemia (PHC). Methods Clinical data of 95 patients who underwent thyroidectomy in Affiliated Shengjing Hospital of China Medical University from Jan. 2015 to Dec. 2015 were analyzed retrospectively. Results Of the 95 patients, there were 27 patient (28.42%) suffered from PHC (PHC group), and levels of serum calcium in the other 68 patients (71.58%) were normal (normal group). There was no significant difference in levels of serum calcium and PTH between the PHC group and normal group before operation (P > 0.05), but levels of serum calcium and PTH in PHC group were both lower than corresponding index of normal group after operation (P < 0.05). The levels of serum calcium and PTH both decreased in PHC group after operation (P < 0.05), and only PTH level decreased in normal group after operation (P < 0.05). PHC was related with type of operation, who underwent two-side operation had higher risk of PHC (P < 0.05), but there was no significant relationship between PHC and gender or age (P > 0.05). Conclusions PTH is an important factor for PHC. In addition, it is easier to occur PHC when the operative range become bigger.

Citation： ZHANGWei-ming, WANGHai-nan, LIHe, LIANGJie-jia, XUWei-xue, XUJin. The Variation of Parathyroid Hormone after Thyroidectomy and The Exploration of Influence Factors for Postthyroidectomy Hypocalcemia. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(12): 1496-1499. doi: 10.7507/1007-9424.20160377 Copy

1.	American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer; Cooper DS, Doherty GM, et al. Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 2009, 19(11):1167-1214.
2.	陈敏, 伍建春, 魏明辉.甲状腺癌不同手术方式对术后甲状旁腺功能和低钙血症的影响.临床和实验医学杂志, 2015, 14(6):477-479.
3.	Pradeep PV, Ramalingam K. Postoperative PTH measurement is not a reliable predictor for hypocalcemia after total thyroidectomy in vitamin D deficiency:prospective study of 203 cases. World J Surg, 2014, 38(3):564-567.
4.	Del Rio P, Cataldo S, Pisani P, et al. Use of oxidized and regenerated cellulose in thyroid surgery:a prospective analysis as cause of postoperative hypocalcemia on 485 patients consecutively treated. Minerva Endocrinol, 2011, 36(3):157-162.
5.	孙荣昊, 李超, 樊晋川.外科手术初治分化型甲状腺癌后主要并发症及辅助治疗研究进展.中华全科医师杂志, 2013, 12(12):974-976.
6.	Lee YS, Nam KH, Chung WY, et al. Postoperative complications of thyroid cancer in a single center experience. J Korean Med Sci, 2010, 25(4):541-545.
7.	黄国平, 蔡铭智, 陈培臻.甲状腺癌术后低钙血症探讨.实用医学杂志, 2009, 25(15):2501-2502.
8.	Docimo G, Tolone S, Pasquali D, et al. Role of pre and post-operative oral calcium and vitamin D supplements in prevention of hypocalcemia after total thyroidectomy. G Chir, 2012, 33(11-12):374-378.
9.	Rajinikanth J, Paul MJ, Abraham DT, et al. Surgical audit of inadvertent parathyroidectomy during total thyroidectomy:incidence, risk factors, and outcome. Medscape J Med, 2009, 11(1):29.
10.	Tredici P, Grosso E, Gibelli B, et al. Identification of patients at high risk for hypocalcemia after total thyroidectomy. Acta Otorhinolaryngol Ital, 2011, 31(3):144-148.
11.	Nemade SV, Chirmade AP. Post-thyroidectomy early serum ionic calcium level:predictor of prolonged hypocalcemia. Ear Nose Throat J, 2013, 92(8):382-390.
12.	来益, 费梦嘉, 王家东.不同甲状腺手术方式对围手术期血钙浓度的影响.临床耳鼻咽喉头颈外科杂志, 2014, 28(23):1873-1876.
13.	Lindblom P, Westerdahl J, Bergenfelz A. Low parathyroid hormone levels after thyroid surgery:a feasible predictor of hypocalcemia. Surgery, 2002, 131(5):515-520.
14.	AlQahtani A, Parsyan A, Payne R, et al. Parathyroid hormone levels 1 hour after thyroidectomy:an early predictor of postoperative hypocalcemia. Can J Surg, 2014, 57(4):237-240.
15.	Rivere AE, Brooks AJ, Hayek GA, et al. Parathyroid hormone levels predict posttotal thyroidectomy hypoparathyroidism. Am Surg, 2014, 80(8):817-820.
16.	Warren FM, Andersen PE, Wax MK, et al. Intraoperative parathyroid hormone levels in thyroid and parathyroid surgery. Laryngoscope, 2002, 112(10):1866-1870.
17.	吴胜东, 高力, 叶学红, 等.甲状腺癌手术后低钙血症65例临床分析.中国实用外科杂志, 2003, 23(3):158-160.
18.	Chapman DB, French CC, Leng X, et al. Parathyroid hormone early percent change:an individualized approach to predict postthyroidectomy hypocalcemia. Am J Otolaryngol, 2012, 33(2):216-220.
19.	Lang BH, Yih PC, Ng KK. A prospective evaluation of quick intrao-perative parathyroid hormone assay at the time of skin closure in predicting clinically relevant hypocalcemia after thyroidectomy. World J Surg, 2012, 36(6):1300-1306.
20.	Fahad Al-Dhahri S, Al-Ghonaim YA, Sulieman Terkawi A. Accuracy of postthyroidectomy parathyroid hormone and corrected calcium levels as early predictors of clinical hypocalcemia. J Otolaryngol Head Neck Surg, 2010, 39(4):342-348.
21.	徐德全, 代文杰.甲状旁腺激素替代疗法治疗甲状旁腺功能减退研究进展.中国实用外科杂志, 2014, 34(5):459-460.
22.	周广起, 刘新梅, 熊斌, 等.分化型甲状腺癌术后PTH变化及发生低钙血症的临床分析.中国普通外科杂志, 2014, 23(5):700-702.
23.	Alhefdhi A, Mazeh H, Chen H. Role of postoperative vitamin D and/or calcium routine supplementation in preventing hypocalcemia after thyroidectomy:a systematic review and meta-analysis. Oncologist, 2013, 18(5):533-542.
24.	Sanabria A, Dominguez LC, Vega V, et al. Routine postoperative administration of vitamin D and calcium after total thyroidectomy:a meta-analysis. Int J Surg, 2011, 9(1):46-51.
25.	巴合提·卡力甫, 艾则孜·阿不都热依木, 赛力克·马高维亚, 等.超声刀在甲状腺切除术中应用效果的Meta分析.中国普通外科杂志, 2013, 22(5):601-607.
26.	Pisanu A, Podda M, Reccia I, et al. Systematic review with meta-analysis of prospective randomized trials comparing minimally invasive video-assisted thyroidectomy (MIVAT) and conventional thyroidectomy (CT). Langenbecks Arc Surg, 2013, 398(8):1057-1068.

1. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer; Cooper DS, Doherty GM, et al. Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 2009, 19(11):1167-1214.
2. 陈敏, 伍建春, 魏明辉.甲状腺癌不同手术方式对术后甲状旁腺功能和低钙血症的影响.临床和实验医学杂志, 2015, 14(6):477-479.
3. Pradeep PV, Ramalingam K. Postoperative PTH measurement is not a reliable predictor for hypocalcemia after total thyroidectomy in vitamin D deficiency:prospective study of 203 cases. World J Surg, 2014, 38(3):564-567.
4. Del Rio P, Cataldo S, Pisani P, et al. Use of oxidized and regenerated cellulose in thyroid surgery:a prospective analysis as cause of postoperative hypocalcemia on 485 patients consecutively treated. Minerva Endocrinol, 2011, 36(3):157-162.
5. 孙荣昊, 李超, 樊晋川.外科手术初治分化型甲状腺癌后主要并发症及辅助治疗研究进展.中华全科医师杂志, 2013, 12(12):974-976.
6. Lee YS, Nam KH, Chung WY, et al. Postoperative complications of thyroid cancer in a single center experience. J Korean Med Sci, 2010, 25(4):541-545.
7. 黄国平, 蔡铭智, 陈培臻.甲状腺癌术后低钙血症探讨.实用医学杂志, 2009, 25(15):2501-2502.
8. Docimo G, Tolone S, Pasquali D, et al. Role of pre and post-operative oral calcium and vitamin D supplements in prevention of hypocalcemia after total thyroidectomy. G Chir, 2012, 33(11-12):374-378.
9. Rajinikanth J, Paul MJ, Abraham DT, et al. Surgical audit of inadvertent parathyroidectomy during total thyroidectomy:incidence, risk factors, and outcome. Medscape J Med, 2009, 11(1):29.
10. Tredici P, Grosso E, Gibelli B, et al. Identification of patients at high risk for hypocalcemia after total thyroidectomy. Acta Otorhinolaryngol Ital, 2011, 31(3):144-148.
11. Nemade SV, Chirmade AP. Post-thyroidectomy early serum ionic calcium level:predictor of prolonged hypocalcemia. Ear Nose Throat J, 2013, 92(8):382-390.
12. 来益, 费梦嘉, 王家东.不同甲状腺手术方式对围手术期血钙浓度的影响.临床耳鼻咽喉头颈外科杂志, 2014, 28(23):1873-1876.
13. Lindblom P, Westerdahl J, Bergenfelz A. Low parathyroid hormone levels after thyroid surgery:a feasible predictor of hypocalcemia. Surgery, 2002, 131(5):515-520.
14. AlQahtani A, Parsyan A, Payne R, et al. Parathyroid hormone levels 1 hour after thyroidectomy:an early predictor of postoperative hypocalcemia. Can J Surg, 2014, 57(4):237-240.
15. Rivere AE, Brooks AJ, Hayek GA, et al. Parathyroid hormone levels predict posttotal thyroidectomy hypoparathyroidism. Am Surg, 2014, 80(8):817-820.
16. Warren FM, Andersen PE, Wax MK, et al. Intraoperative parathyroid hormone levels in thyroid and parathyroid surgery. Laryngoscope, 2002, 112(10):1866-1870.
17. 吴胜东, 高力, 叶学红, 等.甲状腺癌手术后低钙血症65例临床分析.中国实用外科杂志, 2003, 23(3):158-160.
18. Chapman DB, French CC, Leng X, et al. Parathyroid hormone early percent change:an individualized approach to predict postthyroidectomy hypocalcemia. Am J Otolaryngol, 2012, 33(2):216-220.
19. Lang BH, Yih PC, Ng KK. A prospective evaluation of quick intrao-perative parathyroid hormone assay at the time of skin closure in predicting clinically relevant hypocalcemia after thyroidectomy. World J Surg, 2012, 36(6):1300-1306.
20. Fahad Al-Dhahri S, Al-Ghonaim YA, Sulieman Terkawi A. Accuracy of postthyroidectomy parathyroid hormone and corrected calcium levels as early predictors of clinical hypocalcemia. J Otolaryngol Head Neck Surg, 2010, 39(4):342-348.
21. 徐德全, 代文杰.甲状旁腺激素替代疗法治疗甲状旁腺功能减退研究进展.中国实用外科杂志, 2014, 34(5):459-460.
22. 周广起, 刘新梅, 熊斌, 等.分化型甲状腺癌术后PTH变化及发生低钙血症的临床分析.中国普通外科杂志, 2014, 23(5):700-702.
23. Alhefdhi A, Mazeh H, Chen H. Role of postoperative vitamin D and/or calcium routine supplementation in preventing hypocalcemia after thyroidectomy:a systematic review and meta-analysis. Oncologist, 2013, 18(5):533-542.
24. Sanabria A, Dominguez LC, Vega V, et al. Routine postoperative administration of vitamin D and calcium after total thyroidectomy:a meta-analysis. Int J Surg, 2011, 9(1):46-51.
25. 巴合提·卡力甫, 艾则孜·阿不都热依木, 赛力克·马高维亚, 等.超声刀在甲状腺切除术中应用效果的Meta分析.中国普通外科杂志, 2013, 22(5):601-607.
26. Pisanu A, Podda M, Reccia I, et al. Systematic review with meta-analysis of prospective randomized trials comparing minimally invasive video-assisted thyroidectomy (MIVAT) and conventional thyroidectomy (CT). Langenbecks Arc Surg, 2013, 398(8):1057-1068.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The Variation of Parathyroid Hormone after Thyroidectomy and The Exploration of Influence Factors for Postthyroidectomy Hypocalcemia

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