Prediction of Transient and Permanent Hypoparathyroidism after Total Thyroidectomy Using the Postoperative Serum Parathyroid Hormone Test: When Is the Best Time to Check?

김현주; 유형원; 배인의; 이진욱; 이준협; 김수진; 채영준; 최준영; 이규은

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자료유형: 학술저널

저자정보: 김현주 유형원 배인의 이진욱 이준협 김수진 채영준 최준영 이규은

저널정보: 대한갑상선-내분비외과학회 The Journal of Endocrine Surgery The Journal of Endocrine Surgery 제17권 제3호

발행연도: 2017.1

수록면: 104 - 113 (10page)

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Purpose The usefulness of serum intact parathyroid hormone (iPTH) levels for predicting hypocalcemia after total thyroidectomy is well established. This retrospective cohort study aimed to identify the best time iPTH levels should be checked, and determine the postoperative day 1 iPTH level that most safely predict the development of permanent hypoparathyroidism after total thyroidectomy. Methods All consecutive patients who underwent total thyroidectomy in 2013–2015 were identified, retrospectively. iPTH was measured at 2 hours after thyroidectomy, and on postoperative days 1 and 2, and 12 months after surgery. Results In total, 730 patients were included. Their iPTH levels on postoperative day 2 correlated better with postoperative day 1 levels (Pearson's r=0.915) than with iPTH levels at 2 hours after total thyroidectomy (r=0.786). Fourteen patients had normal iPTH levels at 2 hours after thyroidectomy but abnormal levels on postoperative days 1 and 2. On the other hand, 38 patients had abnormal iPTH levels at 2 hours after thyroidectomy but normal values on postoperative days 1 and 2. Receiver operating characteristic analysis showed that the iPTH value of 3.05 pg/mL best predicted permanent hypoparathyroidism (sensitivity, 92.9%; specificity, 99.7%). The safe cutoff value was 9.65 pg/mL (sensitivity, 70.9%; specificity, 100%). Conclusion A single measurement of iPTH on postoperative day 1 predicted patients at risk of transient hypocalcemia more accurately than measurements at 2 hours after surgery, and thus, can serve widely as a predictor of permanent hypoparathyroidism.

#Hypoparathyroidism #Hypocalcemia #Parathyroid hormone #Thyroidectomy #Parathyroid glands

참고문헌 (24)

참고문헌 신청

AES Guidelines 06/01 Group / 2007 / Australian Endocrine Surgeons Guidelines AES06/01. Postoperative parathyroid hormone measurement and early discharge after total thyroide

AlQahtani A / 2014 / Parathyroid hormone levels 1 hour after thyroidectomy: an early predictor of postoperative hypocalcemia / Can J Surg 57 : 237 ~ 240

Asari R / 2008 / Hypoparathyroidism after total thyroidectomy: a prospective study / Arch Surg 143 : 132 ~ 137

Carr AA / 2014 / A single parathyroid hormone level obtained 4 hours after total thyroidectomy predicts the need for postoperative calcium supplementation / J Am Coll Surg 21

Cayo AK / 2012 / Predicting the need for calcium and calcitriol supplementation after total thyroidectomy: results of a prospective, randomized study / Surgery 152 : 1059 ~

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