Assessing Symptomatic Hypocalcemia Risk After Total Thyroidectomy: A Prospective Study.

IF 1 Q3 OTORHINOLARYNGOLOGY
International Archives of Otorhinolaryngology Pub Date : 2024-02-05 eCollection Date: 2024-01-01 DOI:10.1055/s-0043-1777450
Andro Košec, Ana Gašić, Filip Hergešić, Ivan Rašić, Vesna Košec, Vladimir Bedeković
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引用次数: 0

Abstract

Introduction  The most common postoperative complication of total thyroidectomy is hypocalcemia, usually monitored using serum parathyroid hormone and calcium values. Objective  To identify the most accurate predictors of hypocalcemia, construct a risk assesment algorithm and analyze the impact of using several calcium correction formulas in practice. Methods  A prospective, single-center, non-randomized longitudinal cohort study on 205 patients undergoing total thyroidectomy. Parathyroid hormone, serum, and ionized calcium were sampled post-surgery, with the presence of symptomatic or laboratory-verified asymptomatic hypocalcemia designated as primary outcome measures. Results  Parathyroid hormone sampled on the first postoperative day was the most sensitive predictor of symptomatic hypocalcemia development (sensitivity 80.22%, cut-off value ≤2.03 pmol/L). A combination of serum calcium and parathyroid concentration sampled on the first postoperative day predicted the development of hypocalcemia during recovery with the highest sensitivity and specificity (94% sensitivity, cut-off ≤2.1 mmol/L, and 89% specificity, cut-off ≤1.55 pmol/L, respectively). The use of algorithms and correction formulas did not improve the accuracy of predicting symptomatic or asymptomatic hypocalcemia. Conclusions  The most sensitive predictor of symptomatic hypocalcemia present on the fifth postoperative day was PTH sampled on the first postoperative day. The need for algorithms and correction formulas is limited.

评估全甲状腺切除术后症状性低钙血症的风险:一项前瞻性研究
引言 甲状腺全切除术术后最常见的并发症是低钙血症,通常使用血清甲状旁腺激素和血钙数值进行监测。目的 确定低钙血症最准确的预测因素,构建风险评估算法,并分析在实践中使用多种钙校正公式的影响。方法 对 205 名接受全甲状腺切除术的患者进行前瞻性、单中心、非随机纵向队列研究。手术后对甲状旁腺激素、血清和离子钙进行采样,以是否出现无症状或实验室证实的无症状低钙血症为主要结果指标。结果 术后第一天采样的甲状旁腺激素是预测症状性低钙血症发生的最灵敏指标(灵敏度为80.22%,临界值≤2.03 pmol/L)。术后第一天采样的血清钙和甲状旁腺浓度组合预测恢复期低钙血症的发生具有最高的灵敏度和特异性(灵敏度为94%,临界值≤2.1 mmol/L;特异性为89%,临界值≤1.55 pmol/L)。使用算法和校正公式并不能提高预测无症状或无症状低钙血症的准确性。结论 对术后第五天出现的无症状低钙血症最敏感的预测指标是术后第一天采样的 PTH。对算法和校正公式的需求有限。
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来源期刊
CiteScore
2.80
自引率
0.00%
发文量
84
审稿时长
12 weeks
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