갑상선 전절제술 후 저칼슘혈증을 예측하기 위한 부갑상선호르몬 수치
The Predictive Value of Serum Parathyroid Hormone Levels for the Occurrence of Hypocalcemia Following Total Thyroidectomy
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: The aim of study was to determine the cut-off value of serum parathyroid hormone levels with a predictive value for the occurrence of clinical hypocalcemia following total thyroidectomy. Methods: We performed a retrospective review, of 150 patients who underwent total thyroidectomy for papillary thyroid carcinoma from January 2010 to July 2010. We measured the serum levels of parathyroid hormone and phosphate within 18∼24 hours postoperatively. The serum levels of ionized calcium were measured immediately and within 18∼24 hours postoperatively. We also determined the cut-off value, sensitivity and specificity of serum levels of parathyroid hormone, ionized calcium, and phosphate with a predictive value for the occurrence of clinical hypocalcemia. Results: Serum levels of parathyroid hormone were 2.0±1.7 pg/ml in the clinical hypocalcemia group, 9.9±10.7 pg/ml in the asymptomatic hypocalcemia group, and 15.3±10.7 pg/ml in the normal control group (P＜0.001). Serum levels of ionized calcium were also significantly lower in the clinical hypocalcemia group (0.92±0.16 mmol/L) compared with the normal control group (P=0.002). On the other hand, serum levels of phosphate were significantly higher in the clinical hypocalcemia group (P=0.009). The cut-off value of serum parathyroid hormone levels for the prediction of clinical hypocalcemia was 4.5 pg/ml, where the sensitivity, specificity, positive predictive value, and negative predictive value were 87.5%, 63.4%, 89.3% and 59%, respectively. Conclusion: Serum parathyroid hormone levels following total thyroidectomy are the most powerful predictive factors for the occurrence of clinical hypocalcemia. Our results show that the incidence of clinical hypocalcemia is relatively higher at postoperative serum levels of parathyroid hormone ≤4.5 pg/ml.
Abstract
Purpose: The aim of study was to determine the cut-off value of serum parathyroid hormone levels with a predictive value for the occurrence of clinical hypocalcemia following total thyroidectomy. Methods: We performed a retrospective review, of 150 patients who underwent total thyroidectomy for papillary thyroid carcinoma from January 2010 to July 2010. We measured the serum levels of parathyroid hormone and phosphate within 18∼24 hours postoperatively. The serum levels of ionized calcium were measured immediately and within 18∼24 hours postoperatively. We also determined the cut-off value, sensitivity and specificity of serum levels of parathyroid hormone, ionized calcium, and phosphate with a predictive value for the occurrence of clinical hypocalcemia. Results: Serum levels of parathyroid hormone were 2.0±1.7 pg/ml in the clinical hypocalcemia group, 9.9±10.7 pg/ml in the asymptomatic hypocalcemia group, and 15.3±10.7 pg/ml in the normal control group (P＜0.001). Serum levels of ionized calcium were also significantly lower in the clinical hypocalcemia group (0.92±0.16 mmol/L) compared with the normal control group (P=0.002). On the other hand, serum levels of phosphate were significantly higher in the clinical hypocalcemia group (P=0.009). The cut-off value of serum parathyroid hormone levels for the prediction of clinical hypocalcemia was 4.5 pg/ml, where the sensitivity, specificity, positive predictive value, and negative predictive value were 87.5%, 63.4%, 89.3% and 59%, respectively. Conclusion: Serum parathyroid hormone levels following total thyroidectomy are the most powerful predictive factors for the occurrence of clinical hypocalcemia. Our results show that the incidence of clinical hypocalcemia is relatively higher at postoperative serum levels of parathyroid hormone ≤4.5 pg/ml.
참고문헌 (30)
- "Ministry for Health, Welfare and Family Affairs. Annual Report of Cancer incidence (2007), cancer prevalence (2007), and survival (1993-2007) in Korea" (2009), Ministry for Health, Welfare and Family Affairs
- Bergamaschi R, "Morbidity of thyroid surgery", Am J Surg, 176, pp.71~75 (1998)
- Abboud B, "Risk factors for postthyroidectomy hypocalcemia", J Am Coll Surg, 195, pp.456~461 (2002)
- Jumaily JS, "Prediction of hypocalcemia after using 1- to 6-hour postoperative parathyroid hormone and calcium levels: an analysis of pooled individual patient data from 3 observational studies", Head Neck, 32, pp.427~434 (2010)
- Lo CY, "Postthyroidectomy hypocalcemia", J Am Coll Surg, 196, pp.497~498 (2003)
- Martin KJ, "The peripheral metabolism of parathyroid hormone", N Engl J Med, 301, pp.1092~1098 (1979)
- Daniel O, "Surgery of the thyroid and parathyroid glands, Surgery of the Thyroid and Parathyroid Glands", pp.221~224 (2003), Elsevier Saunders
- Kang BG, "Predicting hypocalcemia after total thyroidectomy in patients with thyroid carcinoma", Korean J Endocrine Surg, 8, pp.256~259 (2008)
- Demeester-Mirkine N, "Hypocalcemia after thyroidectomy", Arch Surg, 127, pp.854~858 (1992)
- Bourrel C, "Modigliani E, et al. Transient hypocalcemia after thyroidectomy", Ann Otol Rhinol Laryngol, 102, pp.496~501 (1993)
- Jafari M, "Prospective study of early predictive factors of permanent hypocalcemia after bilateral thyroidectomy", Ann Chir, 127, pp.612~618 (2002)
- Romanus ME, "Transplantation of the parathyroid glands, Endocrine Surgery.", pp.25~40 (1983), Butterworth
- Herranz-González J, "Complications following thyroid surgery", Arch Otolaryngol Head Neck Surg, 117, pp.516~518 (1991)
- Moulton-Barrett R, "Complications of thyroid surgery", Int Surg, 82, pp.63~66 (1997)
- Shindo ML, "Safety of thyroidectomy in residency: a review of 186 consecutive cases", Laryngoscope, 105, pp.1173~1175 (1995)
- Shaha A, "Complications of thyroid surgery performed by residents", Surgery, 104, pp.1109~1114 (1988)
- Beom WS, "A clinical study of thyroidectomy complications: hoarseness, hypocalcemia and hematoma", Korean J Endocrine Surg, 7, pp.252~256 (2007)
- Hong SJ, "The risk factors of hypocalcemia after total thyroidectomy: what is the main cause of transient hypocalcemia?", Korean J Endocrine Surg, 5, pp.87~92 (2005)
- Thomusch O, "The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients", Surgery, 133, pp.180~185 (2003)
- Noordzij JP, "Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies", J Am Coll Surg, 205, pp.748~754 (2007)
- Lecerf P, "Parathyroid hormone decline 4 hours after total thyroidectomy accurately predicts hypocalcemia", Surgery, 152, pp.863~868
- Lombardi CP, "Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurement", Surgery, 136, pp.1236~1241 (2004)
- Payne RJ, "Same-day discharge after total thyroidectomy: the value of 6-hour serum parathyroid hormone and calcium levels", Head Neck, 27, pp.1~7 (2005)
- 장호영, "갑상선 절제 시 수술 당일 부갑상선 호르몬 수치와 저칼슘혈증의 예측도", 대한외과학회지, 71(4), pp.250~255 (2006), 대한외과학회
- Kim HY, "Early predictor of hypocalcemia after total thyroidectomy", J Korean Thyroid Assoc, 3, pp.160~165 (2010)
- Del Rio P, "The utility of serum PTH assessment 24 hours after total thyroidectomy", Otolaryngol Head Neck Surg, 132, pp.584~586 (2005)
- Ghaheri BA, "Perioperative parathyroid hormone levels in thyroid surgery", Laryngoscope, 116, pp.518~521 (2006)
- Wong C, "Hypocalcaemia andparathyroid hormone assayfollowing total thyroidectomy: predicting the future", World J Surg, 30, pp.825~832 (2006)
- Pfleiderer AG, "The timing of calcium measurements in helping to predict temporary and permanent hypocalcaemia in patients having completion and total thyroidectomies", Ann R Coll Surg Engl, 91, pp.140~146 (2009)
- Sousa Ade A, "Evolution of blood magnesium and phosphorus ion levels following thyroidectomy and correlation with total calcium values", Sao Paulo Med J, 128, pp.268~271 (2010)