Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2013, vol. 22, nr 5, September-October, p. 675–682

Publication type: original article

Language: English

Clinical and Biochemical Factors Affecting Postoperative Hypocalcemia After Near-Total Thyroidectomy

Czynniki kliniczne oraz biochemiczne wpływające na pooperacyjną hipokalcemię po prawie całkowitej tyroidektomii

Maciej Sebastian1,A,B,C,D,E,F,G, Jerzy Rudnicki1,A,B,C,D,E,F,G, Witold Jakubaszko1,A,B,C,D,E,F,G, Dorota Zyśko2,A,B,C,D,E,F,G, Anil Kumar Agrawal3,A,B,C,D,E,F,G, Agata Sebastian4,A,B,C,D,E,F,G

1 Department of Minimally Invasive Surgery and Proctology, Wroclaw Medical University, Poland

2 Teaching Department for Emergency Medical Services, Wroclaw Medical University, Poland

3 2nd Department and Clinic of General and Oncological Surgery, Wroclaw Medical University, Poland

4 Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Poland

Abstract

Background. The most common complication which occurs after thyroidectomy is postoperative hypocalcemia due to parathyroid gland damage. It usually appears 24–48 hours postoperatively, but there are clinical and biochemical factors which may contribute to its earlier diagnosis.
Objectives. The aim of this study was to assess clinical and biochemical factors which can influence postoperative hypocalcemia after near-total thyroidectomy.
Material and Methods. The material consisted of 103 patients with benign nodular goiter. In all patients the blood samples were taken 4 times and levels of total calcium, magnesium, inorganic phosphorus, parathormone and thyroid-stimulating hormone were measured. One day before surgery and during the first three days postoperatively patients were asked about symptoms of hypocalcemia and the presence or absence of a Trousseau sign was observed.
Results. There was no statistically significant connection between the symptoms of hypocalcemia and the age of patients and preoperative hyperthyroidism. Patients with symptomatic hypocalcemia had longer operating time, resected tissue weighed more and hospitalization time was longer than in patients without symptoms of hypocalcemia. Concomitant occurrence of hypocalcemia and hypomagnesemia postoperatively was found in 16% of patients. Changes in parathyroid hormone concentration measured 10 min after thyroid excision were more sensitive and specific for detecting patients with symptomatic hypocalcemia after surgery than total calcium concentration.
Conclusion. Measurement of intraoperative parathormone level 10 min after thyroidectomy is a highly sensitive and specific factor for detecting postoperative hypocalcemia. If we connect this parameter with some other clinical features, it will be possible to predict postoperative hypocalcemia more accurately and introduce supplementation as early as possible.

Streszczenie

Wprowadzenie.Najczęściej występującym powikłaniem po tyroidektomii jest pooperacyjna hipokalcemia wskutek zniszczenia gruczołów przytarczycznych. Pojawia się zwykle 24–48 godzin po zabiegu chirurgicznym, istnieją jednak kliniczne oraz biochemiczne czynniki mogące prowadzić do jej wcześniejszego rozpoznania.
Cel pracy. Określenie czynników klinicznych oraz biochemicznych mających wpływ na pojawienie się hipokalcemii po prawie całkowitej tyroidektomii.
Materiał i metody. Analizie poddano 103 pacjentów z łagodnym wolem guzkowym. U wszystkich badanych osób pobrano 4-krotnie krew i oznaczono stężenie wapnia całkowitego, magnezu, fosforu nieorganicznego, parathormonu oraz hormonu tyreotropowego. Jeden dzień przed zabiegiem chirurgicznym oraz przez 3 kolejne dni po zabiegu pacjenci byli pytani o obecność objawów hipokalcemii oraz wykonano próbę Trousseau.
Wyniki. Nie stwierdzono statystycznie istotnej zależności między wystąpieniem objawów hipokalcemii a wiekiem pacjentów i przedoperacyjnie rozpoznaną nadczynnością tarczycy. U pacjentów z objawową hipokalcemią zabieg chirurgiczny trwał dłużej, usunięta tkanka ważyła więcej i czas hospitalizacji był dłuższy niż u pacjentów bez objawów hipokalcemii. Jednoczesne występowanie hipokalcemii i hipomagnezemii w okresie pooperacyjnym stwierdzono u 16% pacjentów. Zmiany w stężeniu parathormonu, stwierdzone 10 min po usunięciu tarczycy, były bardziej czułe i swoiste dla wykrycia pacjentów z objawową hipokalcemią niż zmiany w stężeniu wapnia całkowitego.
Wnioski. Śródoperacyjne oznaczanie parathormonu 10 min po usunięciu tarczycy jest wysoce czułym i swoistym czynnikiem dla wykrycia pooperacyjnej hipokalcemii. Jeśli połączy się to oznaczenie z innymi czynnikami klinicznymi, będzie możliwe dokładniejsze przewidywanie wystąpienia pooperacyjnej hipokalcemii i jak najszybsze włączenie suplementacji.

Key words

hypocalcemia, hypomagnesemia, parathyroid glands, thyroidectomy, hypoparathyroidism.

Słowa kluczowe

hipokalcemia, hipomagnezemia, gruczoły przytarczyczne, tyroidektomia, niedoczynność gruczołów przytarczycznych.

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