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目的 探讨甲状腺手术病人甲状旁腺素（PTH）测定与术后低钙血症发生率的关系，总结术后低钙血症的预防和治疗经验。方法 2004年1月至2007年8月对南京医科大学附属无锡市第二人民医院收治的592例甲状腺病人分别于术前．术中切除标本后10min、术后第1、2天测血清门H值，术前、术后第1、2、3天动态监测血清钙离子变化。结果 甲状腺手术后出现低钙血症86例，术中切除标本10min后PTH≤15ng／L（14．19％）及术后第1天≤10ng／L（8．28％）者低钙血症发生率与〉15ng／L（0．34％）、〉10ng／L（6．25％）者相比差异有统计学意义；将切除后10min PTH下降〉75％做为预测术后低钙血症的指标。其敏感性、特异度分别为100％、94．51％。结论 术中切除标本后10min门H下降〉75％时可做为预测术后低钙血症的指标；甲状腺手术后3d内血钙变化最显著；一侧甲状腺全切除＋对侧次全切除及切除范围更大的病人，应常规行术中门H测定，并据情况适当补充钙剂，可以防止低钙症状的发生。     

分化型甲状腺癌术后PTH变化及发生低钙血症的临床分析

目的：探讨分化型甲状腺癌不同手术方式后PTH和血钙的变化,总结手术方式与PTH及低钙血症的关系。 方法：检测2012年10月—2013年9月167例分化型甲状腺癌患者术前、术后10 min、术后第1、2天PTH水平及术前、术后第1、2、3天血钙水平变化,进行统计学分析。 结果：分化型甲状腺癌手术后,手术方式中行甲状腺近全切除+中央组淋巴结清扫者,术后低钙血症发生率均较高;术后发生低钙血症者PTH水平显著降低（P<0.05）。 结论：分化型甲状腺癌手术后均可影响甲状旁腺功能,手术越大术后发生低钙血症可能越大。PTH水平降低是术后低钙血症发生的主要因素。

     

61例尿毒症患者甲状旁腺全切加前臂移植术后低钙血症的发生与处理

目的针对内科治疗无效的继发性甲状旁腺功能亢进（sHPT）的尿毒症患者行甲状旁腺全切加前臂移植术,分析术后患者低钙血症的发生与处理。方法61例患者术后立即监测血钙浓度,并静脉补充葡萄糖酸钙,使血钙维持在1．8～2．2mmol／L之间,统计手术前、后患者的全段甲状旁腺激素（iPTH）、血清钙磷乘积和碱性磷酸酶（AKP）水平以及手术切除的总的腺体质量。结果56例患者（占91．7％）术后12-24h即出现血钙低于1．8mmol／L,静脉立即补充葡萄糖酸钙,约合元素钙（18±6）g,补钙剂量与术前血iPTH（r=0．621,P〈0．01）、钙磷乘积（r=0．719,P〈0．01）、AKP（r=0．606,P〈0．01）及总的切除腺体质量（r=0．716,P〈0．01）相关。结论低钙血症是患者甲状旁腺术后的常见表现,与SHPT的严重程度有关,术后及早监测血钙和静脉补钙可有效、安全预防严重低钙血症的发生。     

甲状腺癌术后甲状旁腺素检测对预测低钙血症的作用

目的探讨术后检测甲状旁腺素(PTH)对预测低钙血症的作用,为指导临床及时补钙提供参考。方法选取2016年1月至2018年3月于医院治疗的80例甲状腺癌患者作为研究对象,均行手术治疗,术后1小时检测患者PTH水平,并进行分组,对照组(40例,PTH≥15 ng/L,非损伤,则不需补钙)与观察组(40例,PTH15 ng/L,损伤,则补钙)。分别检测两组患者术前、术后1、3、7、30天时PTH和血钙水平,记录两组术后症状性低钙血症发生情况。结果两组术前、术后7、30天时PTH水平比较,P0.05;两组术后1小时、1天、3天时PTH水平比较,P0.05。两组术前、术后各时段血钙水平比较,P0.05。观察组术后发生症状性低钙血症率为12.5%(5/40)与对照组7.5%(3/40)比较,χ~2=0.555,P=0.456。结论对术后1小时甲状旁腺素偏低者需及时实施预防性补钙以预防低钙血症发生,对促进患者甲状旁腺功能具有重要作用。     

血液透析患者甲状旁腺全切除加上臂移植术后低钙血症的防治

目的 观察因继发性甲状旁腺功能亢进症（secondary hyperparathyroidism,SHPT）进行甲状旁腺全切除加上臂移植术（total parathyroidectomy with upper arm autograft,TPTX＋AT）的血液透析患者,术后使用不同钙离子浓度的透析液行透析治疗低钙血症的效果,探讨如何更有效防治术后低钙血症.方法 选择2011年3月至2013年6月在我院接受TPTX＋AT的血液透析患者29例,按照手术时间的先后顺序进行编号,随机将偶数分在A组14例,奇数分在B组15例.术前B组补钙及骨化三醇;术后2组均予补钙及骨化三醇.A组使用钙浓度1.50 mmol/L透析液,B组使用钙浓度1.75 mmol/L高钙透析液.观察术后8 h、24 h、48 h、1周、2周及4周的血钙、血磷及甲状旁腺素（intact parathyroid hormone,iPTH）的变化,记录低钙血症的临床症状,术后达到治疗目标所需要的时间及静脉补钙量.结果 术后血钙、血磷、iPTH均明显下降.术后低钙血症主要表现四肢末端发麻,全身无力,焦虑、烦躁;少数患者表现为心悸、多汗、肌肉痉挛、四肢抽搐,血压低、腹痛或腹泻.A组低钙血症发生率为 85.7%（12/14）、B组为 73.3%（11/15）.术后1周B组血钙水平[（1.95±0.18）mmol/L]明显高于A组[（1.76±0.21）mmol/L].B组术后达到治疗目标所需要的时间为[（7.56±2.25）d],少于A组[（10.54±3.12）d];而B组所需静脉补钙量[（6.86±2.13）g]少于A组[（9.28±2.81）g],差异均有统计学意义（P＜0.05）.结论 并发SHPT的血液透析患者在TPTX＋AT术后常会出现低钙血症,术前、术后足量补充钙剂和骨化三醇,术后使用高钙透析液透析能更加有效防治低钙血症.     

全甲状腺切除术后甲状旁腺的功能监测

目的 评估全甲状腺切除术后甲状旁腺功能减退症发生情况,探索早期预测术后低钙血症的方法.方法 对124例患者(甲状腺癌46例、结节性甲状腺肿78例)行全甲状腺切除术,恶性患者加行淋巴结清扫术,术前、术后1 h、1 d、2 d检测血钙和血PTH,观察术后甲状旁腺功能减退症发生情况,并用受试者工作特征曲线研究低钙血症早期预测指标.结果 58例发生术后暂时性甲状旁腺功能减退症(46.8%),甲状腺癌组22例(47.8%),结节性甲状腺肿组36例(46.2%),两组之间无明显差异(λ2=0.033,P=0.857);1例发生永久性甲状旁腺功能减退症(0.8%),发生在甲状腺癌组.术后90例(72.6%)出现血钙下降,58例(46.8%)出现血PTH下降,40例(32.3%)出现低钙症状.甲状腺癌组术后血钙(F=21.358,P=0.000)、血PTH(F=18.253,P=0.000)下降程度重于结节性甲状腺肿组,术后1 h血PTH下降百分比可很好的预测有临床症状的低钙血症(曲线下面积为0.933),以PTH下降76.6%作为分界点,此时预测有临床症状的低钙血症的敏感性为89.7%,特异性为87.9%. 结论全甲状腺切除术加行淋巴结清扫会加重术后血钙、血PTH下降程度但不会增加甲状旁腺功能减退症发生率;术后1 h血PTH下降百分比可预测低钙血症的发生.     

甲状腺术后低钙血症的预防和治疗

甲状腺术后病人常有低钙血症 ,原因是多方面的[1～ 4] :首先是围手术期的血液稀释 ,也是其他非甲状腺病人术后发生低钙血症的主要原因 ;其次 ,对甲状腺的手术操作可引起血液降钙素浓度升高 ,从而导致血钙降低。甲亢病人由于胃肠道对钙的吸收减少 ,为维持正常血钙浓度而动员骨钙释放到血液中 ,造成所谓“骨饥饿综合征” ;手术后骨组织反过来吸收血钙以补充骨钙的不足从而造成低钙血症。这也是甲亢病人术后低钙血症比相同术式的其他甲状腺病人更明显的原因。当然 ,引起甲状腺术后低钙血症的最主要原因是术中甲状旁腺或其血供损伤而致的甲状旁…     

甲状腺手术后甲状旁腺激素值低下是低钙血症的可行性预测指标

甲状腺手术后需测定血钙值 ,对双侧甲状腺大部切除后长期测定很费时 ,如能在术后第一天就能采用一种方法预测低钙血症则很有价值 ,因为习用的血钙测定方法受术后血液稀释而不精确。应用术中甲状旁腺激素 (PTH)测定可预测低钙血症的发生。作者研究 38例甲状腺手术病人 ,计男 6例 ,女 32例 ,中位值年龄 35岁 (15～ 80岁 ) ;甲亢 2 6例 ,甲状腺肿 10例 ,Plummer病 (毒性甲状腺腺瘤 )和乳头状甲状腺癌各 1例。 18例行近似甲状腺全切除 ,2 0例行甲状腺全切除 ,保护好甲状旁腺。比较习用的生化性低钙血症 (非症状性 )测定方法 (血清钙术后次晨低…     

Focus超声刀在甲状腺手术中甲状旁腺的功能保护及对术后血钙水平的影响

目的探讨Focus超声刀在甲状腺手术中的应用及其对甲状旁腺的功能保护作用,以及围手术期患者血钙水平的变化。方法选取本院2010年5月至2011年5月实施的甲状腺手术226例,采用传统手术方式,设为对照组;选取2011年6月至2012年6月实施的甲状腺手术250例,应用Focus超声刀实施手术,设为观察组。比较两组患者的手术效果与效率,术前、术后3天血清甲状旁腺素、血钙及血磷水平,观察甲状旁腺功能损伤患者治疗及随访结果。结果两组患者手术过程均比较顺利,无术中及住院期间死亡病例,术后病理诊断均与临床诊断一致;观察组患者手术时间、术中出血量、术后引流量、平均住院时间均少于（或短于）对照组（P〈0．01或P〈O．05）;观察组低钙血症、血钙下降的发生率均低于对照组（P〈0．01或P〈0．05）。术前两组患者血清甲状旁腺素、血钙、血磷比较,差异均无统计学意义（P〉0．05）;术后,对照组血清甲状旁腺素、血钙水平降低,血磷水平升高（P〈0．01或P〈0．05）,表明对照组患者甲状旁腺功能损伤;观察组患者手术前后甲状旁腺功能比较稳定。术后3月内,所有甲状旁腺功能损伤患者均恢复至正常范围,无永久性甲状旁腺功能减退的发生。结论Focus超声刀在甲状腺手术中对甲状旁腺具有较好的保护作用,术中组织分离、止血效果确切,损伤较小．术后患者血清甲状旁腺功能指标稳定,恢复较快,是目前比较优化的一种手术措施。     

甲状腺癌手术中甲状旁腺的识别和保护

目的 探讨甲状腺癌手术中甲状旁腺的保护方法,降低术后甲状旁腺功能减退的并发症.方法 2013年3月-2014年2月行全甲状腺切除术+Ⅵ区淋巴结清扫术的甲状腺患者107例,术中根据典型外观对甲状旁腺进行识别并原位保留;在已切除的甲状腺表面和Ⅵ区淋巴结标本中仔细寻找辨认甲状旁腺,疑似组织切取一部分送术中冰冻检查,证实后剩余组织移植于胸锁乳突肌中;根据术后病理诊断报告,确定在甲状腺及Ⅵ区淋巴结标本中有无被切除的甲状旁腺;术后1～3d连续监测血钙并对症处理.结果 甲状旁腺的误切率为11.4％,离体旁腺的自体移植率为54.4％,低钙血症发病率32.7％,有症状低钙血症发病率16.8％,无永久性低钙血症发生.结论 在甲状腺癌的手术治疗中,准确识别甲状旁腺是实现原位保留和自体移植的前提,是减少误切、降低术后低钙血症的有效方法.     

Risk factors for postoperative hypocalcemia after surgery for primary hyperparathyroidism

HYPOTHESIS: A variety of clinical and biochemical variables may be associated with hypocalcemia after surgery for parathyroid adenoma. DESIGN: A prospective study of patients who underwent surgery for solitary parathyroid adenoma. SETTING: A university hospital department of surgery. PATIENTS: Eighty-six consecutive patients who underwent surgery for solitary parathyroid adenoma. INTERVENTION: Parathyroidectomy according to the principles of unilateral neck exploration. MAIN OUTCOME MEASURES: Clinical and biochemical risk factors for early (< or =4 days after surgery) and late (1 year after surgery) postoperative symptomatic and biochemical hypocalcemia. RESULTS: Twenty-two patients developed early symptomatic hypocalcemia. The difference in total serum calcium levels between patients, with and without early symptomatic hypocalcemia, was evident on the third and fourth postoperative days. Serum level of osteocalcin greater than 6.0 microg/L, bilateral neck exploration, and history of cardiovascular disease were risk factors for symptomatic hypocalcemia (odds ratios [95% confidence intervals]: 4.4 [1.4-14.1], 3.8 [1.3-11.6], and 0.1 [0.02-0.60], respectively). Patients with up to 1 risk factor had a possibility of only 7% to develop early symptomatic hypocalcemia. One year after surgery, 16 patients had low levels of total serum calcium (late biochemical hypocalcemia) and were asymptomatic. Preoperative intermittent hypercalcemia was associated with an increased risk for late biochemical hypocalcemia (odds ratio, 3.9; 95% confidence interval, 1.0-16.3). CONCLUSIONS: Clinical and biochemical risk factors for early and late postoperative hypocalcemia in patients who underwent surgery for solitary parathyroid adenoma were found. A clinically useful prognostic index for early symptomatic hypocalcemia was constructed using these risk factors.     

Low parathyroid hormone levels after thyroid surgery: a feasible predictor of hypocalcemia

BACKGROUND: Selecting patients with a low risk of hypocalcemia is mandatory if patients are to be discharged on the first day after bilateral thyroidectomy. This study investigated the predictive value of intraoperative parathyroid hormone (PTH). METHODS: Thirty-eight patients underwent total or near-total thyroidectomy. Patients with or without biochemical and symptomatic hypocalcemia were compared regarding intraoperative PTH levels and previously suggested risk factors. The accuracy of intraoperative PTH to predict patients at risk for postoperative hypocalcemia was compared with a calcium concentration of less than 2.00 mmol/L (8.0 mg/dL) on the first postoperative day. RESULTS: PTH levels after resection of the second lobe, age, and number of parathyroid glands identified intraoperatively were independently associated with the reduction in serum calcium concentration measured at nadir on the first or second postoperative day. PTH levels after resection of the second lobe were lower among patients who developed biochemical (P <.001) and symptomatic hypocalcemia (P <.01) compared with those who did not. Low levels of intraoperative PTH identified the 3 patients who required intravenous calcium during the first 24 postoperative hours. An intraoperative PTH level below reference range and a calcium concentration of less than 2.00 mmol/L measured 1 day postoperatively both predicted biochemical hypocalcemia with a similar sensitivity (90% vs 90%) and specificity (75% vs 82%). Intraoperative PTH was slightly better than a serum calcium concentration of less than 2.00 mmol/L on postoperative day 1 to predict symptomatic hypocalcemia, with a sensitivity of 71% vs 52% and a specificity of 81% vs 76%, respectively. CONCLUSIONS: Parathyroid gland insufficiency is the main determinant of transient hypocalcemia after bilateral thyroid surgery. Low intraoperative PTH levels during thyroid surgery are therefore a feasible predictor of postoperative hypocalcemia.     

Serum intact parathyroid hormone as a predictor of hypocalcaemia after total thyroidectomy

BACKGROUND: Hypocalcaemia from hypoparathyroidism is a complication of total thyroidectomy. The aim of the present study was to determine whether an early postoperative level of serum parathyroid hormone (PTH) after total thyroidectomy predicts the development of significant hypocalcaemia and the need for treatment. METHODS: Patients undergoing total thyroidectomy had their serum level of intact PTH checked 1 h after removal of the thyroid gland. Serum calcium level was checked on the following morning. Oral calcium and/or calcitriol was commenced if the patient developed hypocalcaemic symptoms, or if the corrected serum calcium level was <2.0 mmol/L. RESULTS: Seventy-nine patients were included in the present study. Thirteen patients had symptoms of hypocalcaemia on postoperative days 1 or 2 and 66 patients remained asymptomatic. The postoperative intact PTH, day 1 calcium and day 2 calcium was 0.32 +/- 0.60 pmol/L, 2.01 +/- 0.11 mmol/L, and 2.02 +/- 0.16 mmol/L, respectively, for the symptomatic group and 1.98 +/- 1.25, 2.21 +/- 0.13, and 2.19 +/- 0.14, respectively, for the asymptomatic group. Calcium support was given to 25 patients, of whom 14 also required calcitriol. CONCLUSION: Serum PTH 1-h after total thyroidectomy is a reliable predictor of hypocalcaemia and can allow safe early discharge of patients from hospital.     

A Prophylactic Infusion of Calcium Solution Reduces the Risk of Symptomatic Hypocalcemia in Patients after Total Thyroidectomy

Background Several risk factors have been associated with post-operative transient hypocalcemia after thyroid surgery. However, there are no studies evaluating preventive measures to avoid symptomatic postoperative hypocalcemia. Although intravenous infusion of calcium improves hypocalcemic symptoms, it is unknown whether prophylactic infusion prevents symptoms of postoperative hypocalcemia. Patients and Methods Five hundred and forty-seven patients underwent total thyroidectomy. Two groups were identified: group A (n = 243) received prophylactic intravenous drip infusion of 78–156 mg of calcium solution at 3–8hours after operation, and group B (n = 304) received no prophylactic treatment. Prophylactic infusion was used only once if the patients did not have symptoms of hypocalcemia. Serum calcium (Ca) levels, intact parathyroid hormone (i-PTH) levels on the first postoperative day (1st POD), and the prevalence of symptoms of hypocalcemia were prospectively analyzed. Results The serum Ca levels at the 1st POD in group A patients (7.91 ± 0.49 mg/dl, mean ± SD) was significantly higher than group B patients (7.65 ± 0.54, P < 0.0001), while the serum i-PTH levels were not significantly different between the two groups. The prevalence of numbness and / or tetany before noon on the 1st POD was significantly lower in group A patients. Prophylactic infusion of calcium solution reduced the prevalence of tetany from 8.6% to 2.1%. Conclusion A prophylactic infusion of calcium solution after total thyroidectomy may be useful in reducing the development of symptomatic hypocalcemia and reduces the patients’ risk of having discomfort and anxiety due to hypocalcemia.     

甲状腺不同手术方式对甲状旁腺功能的影响

目的:探讨甲状腺不同手术方式术后甲状旁腺素(PTH)、血钙的变化,总结预防甲状腺术后甲状旁腺功能减退发生的方法及并发症的处理。方法:检测2012年1—5月191例甲状腺手术患者术前及术后血清PTH、血钙,比较术前、术后的变化,并按照手术范围分7组,比较各组之间术后PTH、血钙的变化。结果:各组术后较术前比较,血钙、血PTH均明显下降(P0.05)。同组术后1 d与4 d血PTH、血钙之间比较,差异无统计学意义(P0.05)。各组低血PTH、症状性低钙血症的发生率以及术后PTH下降幅度的比较:全甲状腺切除+双侧颈中央区淋巴清除组、全甲状腺切除+一侧改良颈清+对侧颈中央区淋巴清除组甲状腺双叶切除组甲状腺单叶切除组,其差异有统计学意义(P0.05﹚,而在全甲状腺切除,以及同样范围的颈中央区淋巴清除的基础上,是否行改良颈清,对于术后低PTH血症及症状性低钙血症的发生率以及PTH下降的幅度,差异无统计学意义(P0.05﹚。低血钙的发生率比较:甲状腺单侧腺叶切除与其他6种手术方式比较、甲状腺双侧腺叶切除与全甲状腺切除+一侧改良颈清+对侧颈中央区淋巴清除比较,差异有统计学意义(P0.05﹚。结论:各种甲状腺术式对甲状旁腺功能均有不同程度的影响,手术范围越大,术后并发甲状旁腺功能减退的可能性越大。预防术后甲状旁腺功能减退的根本,就在于术中甲状旁腺的保护。     

Anterior pituitary,thyroid, parathyroid and adrenal responses to subtotal thyroidectomy in patients with Graves’ disease

Changes in the serum levels of anterior pituitary, thyroid, parathyroid, and adrenal hormones following subtotal thyroidectomy in 31 patients with Graves’ disease were investigated. In 14 patients, rapid ACTH tests were performed on the preoperative and the first, third, and seventh postoperative days. Remarkable differences were not seen with regard to the changes in anterior pituitary hormones or cortisol, compared to those seen during general surgery. As to the thyroid hormones, the serum level of triioodothyronine (T₃) decreased markedly after surgery and fell to half that of the preoperative value on the first postoperative day. Thereafter, a low value of T₃ was maintained during the early postoperative period. Unlike T₃, the serum level of thyroxine (T₄) decreased gradually until the 7th post-operative day. The levels of both epinephrine and norepinephrine increased transiently during surgery, but the serum level of norepinephrine increased again on the third postoperative day. In the postoperative period, almost half the number of patients showed an inadequate cortisol response to rapid ACTH tests. It is suggested that the unique responses, such as the rise in serum norepinephrine or an inadequate response of cortisol to ACTH, or hypocalcemia, after subtotal thyroidectomy in patients with Graves’ disease is largely due to the rapid decrease of T₃ in the hypothyroid state, as was noted during the postoperative period.     

甲状腺全切除术后测定甲状旁腺激素对预测低血钙发生的价值

目的 探讨甲状腺全切除术后甲状旁腺激素(PTH)测定在预测有症状低血钙方面的意义.方法 前瞻性地选择2010年6月至2011年12月期间在首都医科大学宣武医院普通外科甲状腺乳腺专业组同一个主诊医师小组接受甲状腺全切除术的连续45例患者,分别于术后1h测定PTH与血钙,并在住院期间每天监测PTH与血钙,记录出现低血钙的症状.利用受试者工作曲线分析预测低血钙的临界值.结果 共45例患者,有9例(20.0％)术后血钙正常;17例(37.8％)术后出现无症状低血钙;19例(42.2％)出现有症状低血钙,需要补充钙剂治疗.血钙正常者、无症状低血钙者及有症状低血钙者术后1 h PTH值分别为(40.5±23.7) ng/L、(18.3±9.1)ng/L及(7.6±4.2)ng/L,方差分析显示,P＜0.001.术后1 h PTH值≤13.4 ng/L可以预测患者将发生低血钙的相关症状,敏感性为94.7％,特异性为76.9％.结论 甲状腺术后1 h PTH值≤13.4 ng/L的患者发生低血钙相关症状的可能性较大,需要补充钙剂治疗以减少患者的不适症状.     

三种甲状腺手术方法对甲状腺、甲状旁腺功能的影响分析

目的探讨三种甲状腺手术方法对甲状腺癌患者甲状腺、甲状旁腺功能的影响。方法回顾性分析2012年至2015年手术治疗的甲状腺癌患者125例,根据手术方式分为3组,其中A组57例行甲状腺全切+颈淋巴结清扫术,B组36例行甲状腺全切除术,C组32例行甲状腺次全切除术。数据分析用SPSS16.0软件进行,甲状腺功能、甲状旁腺功能和血清钙中的指标用均数±标准差(x珋±s)表示,t检验;低血钙发生率用百分率(%)表示,卡方检验;P0.05表示差异具有统计学意义。结果手术后3 d三组患者的T3和FT3以及T4和FT4均显著低于术前,而TSH显著高于术前(P0.05);C组患者的PTH(29.6±12.6)pg/ml显著高于A、B组的患者,且差异具有统计学意义(F=4.568,P0.05);三组甲状腺癌患者术后血清钙均下降,且差异具有统计学意(P0.05),而C组患者的血清钙显著高于A、B组的患者,且术后低血钙发生率(18.7%)也显著低于A(59.6%)、B组(41.67%)的患者,差异均具有统计学意义(P0.05)。结论手术治疗对甲状癌患者的甲状腺功能以及甲状旁腺功能均有显著影响,不同手术方式对甲状腺功能的影响无显著差异,而随着甲状腺手术方式和范围的扩大甲状旁腺功能减退和低血钙发生率增高。     

Hypocalcemia Complicating Near-Total Thyroidectomy in Patients with Coexisting Lipid Malabsorption due to Biliopancreatic Diversion

Background: Patients who have undergone biliopancreatic diversion (BPD) show a high incidence of mild hypocalcemia, which may become symptomatic and life-treating after an extensive thyroid operation. Methods: 4 cases are reported of women who had undergone BPD, who subsequently underwent near-total thyroidectomy for extensive multinodular goiter. Results: The first patient developed severe symptomatic hypocalcemia with malnutrition in the long-term, that required elongation of the common limb of the BPD. The second and third patients developed severe symptomatic hypocalcemia immediately after the thyroidectomy. In the fourth patient, preventive and continuing intravenous administration of calcium gluconate was started in the early hours after the thyroidectomy and allowed a safe and fast discharge home. Conclusion: In patients who are candidates for both thyroid and bariatric surgery, surgeons should carefully evaluate the opportunity to perform the thyroidectomy first. BPD patients who later undergo thyroidectomy should be perioperatively routinely treated with intravenous calcium and, whenever appropriate, intravenous vitamin D, to allow a safe and rapid discharge.     

Predicción de hipocalcemia postiroidectomía mediante determinación de PTH rápida

IntroductionHypocalcemia is the most frequent complication after thyroidectomy. The aim of this work is to identify biochemical risk factors of hypocalcemia using quick perioperative (pre and post-thyroidectomy) intact parathyroid hormone (PTHi) and postoperative calcemias.MethodsIn a consecutive series of 310 total thyroidectomies, samples of quick PTHi at the anaesthetic induction and 10 minutes after surgery, together with serum calcemias every 12 hours were obtained. The sensitivity, specificity, positive and negative predictive value are analyzed and related to hypocalcemia. A control group of hemithyroidectomies is also analyzed to compare the effects of surgery on PTH secretion.ResultsOf the 310 patients, 202 (65.1%) remained normocalcemic and asymptomatic (group A), 108 (34.9%) presented hypocalcemia (Group B), requiring oral calcium (79 symptomatic). After analysis of several cut-off points, combining a PTHr drop gradient of 60% or calcemia inferior to 7.4 mg/dl at 24 hours, a sensitivity of 100% is achieved without leaving false negatives. Compared to the control group, there is a significant difference with respect to the post-operative calcemias and PTHr, p < 0.001.ConclusionsTotal thyroidectomy affects parathyroid function with evident decrease in rPTH and risk of hypocalcemia. The combination of PTHr decrease of 60% or less than 7.4 mg/dl calcemia at 24 hours gives a 100% sensitivity for predicting patients at risk of hypocalcemia.