Abstract：
BACKGROUND: PTH measurement has been proposed to predict transient and permanent postoperative hypocalcemia. There is no standard cut-off point or time for sampling.
OBJECTIVE: To report the incidence of post-thyroidectomy hypocalcemia in a high-volume surgical group and propose an outpatient management protocol according to postoperative (PO) calcium levels, iPTH (normal, low, or undetectable), and symptoms. Furthermore, determine postoperative PTH values as predictors of hypocalcemia.
METHODS: In 106 patients with total thyroidectomy between 2019 and 2021, pre-and postoperative levels of calcium, magnesium, phosphorus, and iPTH were measured.
RESULTS: Transient (< 12 months) and permanent (> 12 months) hypocalcemia was observed in 29% and 1%. Cut-off points to predict hypocalcemia were PTH < 8.8 pg/mL and < 80% decrease in % PTH (d% PTH) the day after surgery. With the proposed management, early discharge is indicated (an average of 1.05 days), and the prescription cost is limited. There is no significant association between PO hypomagnesemia and hyperphosphatemia with PO hypocalcemia. The most widely used treatment is exclusive calcium carbonate (schemes I and II). Patients remain with mild symptoms at two weeks PO in 5% and discontinue oral treatment in 93% in this period.
CONCLUSIONS: Protocols for measuring PTH as a hypocalcemia predictor vary. Each center must know and establish its management protocols. With this experience, we demonstrate the usefulness and safety of a management scheme based on calcium, PTH (normal, low, or undetectable), and symptoms with an indication of prophylactic treatment for all patients and a safe outpatient setting at a lower cost than prolonged hospitalization.
OBJECTIVE: To report the incidence of post-thyroidectomy hypocalcemia in a high-volume surgical group and propose an outpatient management protocol according to postoperative (PO) calcium levels, iPTH (normal, low, or undetectable), and symptoms. Furthermore, determine postoperative PTH values as predictors of hypocalcemia.
METHODS: In 106 patients with total thyroidectomy between 2019 and 2021, pre-and postoperative levels of calcium, magnesium, phosphorus, and iPTH were measured.
RESULTS: Transient (< 12 months) and permanent (> 12 months) hypocalcemia was observed in 29% and 1%. Cut-off points to predict hypocalcemia were PTH < 8.8 pg/mL and < 80% decrease in % PTH (d% PTH) the day after surgery. With the proposed management, early discharge is indicated (an average of 1.05 days), and the prescription cost is limited. There is no significant association between PO hypomagnesemia and hyperphosphatemia with PO hypocalcemia. The most widely used treatment is exclusive calcium carbonate (schemes I and II). Patients remain with mild symptoms at two weeks PO in 5% and discontinue oral treatment in 93% in this period.
CONCLUSIONS: Protocols for measuring PTH as a hypocalcemia predictor vary. Each center must know and establish its management protocols. With this experience, we demonstrate the usefulness and safety of a management scheme based on calcium, PTH (normal, low, or undetectable), and symptoms with an indication of prophylactic treatment for all patients and a safe outpatient setting at a lower cost than prolonged hospitalization.
摘要：
背景：PTH测量已被提出用于预测暂时性和永久性术后低钙血症。没有标准的采样截止点或时间。
目的：报告高容量手术组甲状腺切除术后低钙血症的发生率，并根据术后（PO）钙水平提出门诊管理方案，iPTH（正常，低,或不可检测)，和症状。此外，确定术后PTH值作为低钙血症的预测因子。
方法：在2019年至2021年的106例甲状腺全切除术患者中，术前和术后的钙水平，镁，磷，并测量了iPTH。
结果：观察到29％和1％的暂时性（<12个月）和永久性（>12个月）低钙血症。预测低钙血症的截止点是PTH<8.8pg/mL和手术后第1天PTH(d%PTH)下降<80%。根据提议的管理，指示早期出院(平均1.05天)，处方费用有限。PO低镁血症和高磷血症与PO低钙血症之间没有显着关联。最广泛使用的处理是专用碳酸钙(方案I和II)。患者在两周PO时仍有5％的轻度症状，在此期间有93％的患者停止口服治疗。
结论：测量PTH作为低钙血症预测因子的方案各不相同。每个中心都必须了解并建立其管理协议。有了这个经验,我们证明了基于钙的管理方案的有效性和安全性，PTH（正常，低,或不可检测)，和症状，所有患者都有预防性治疗的指征，而且门诊安全，费用低于长期住院。
目的：报告高容量手术组甲状腺切除术后低钙血症的发生率，并根据术后（PO）钙水平提出门诊管理方案，iPTH（正常，低,或不可检测)，和症状。此外，确定术后PTH值作为低钙血症的预测因子。
方法：在2019年至2021年的106例甲状腺全切除术患者中，术前和术后的钙水平，镁，磷，并测量了iPTH。
结果：观察到29％和1％的暂时性（<12个月）和永久性（>12个月）低钙血症。预测低钙血症的截止点是PTH<8.8pg/mL和手术后第1天PTH(d%PTH)下降<80%。根据提议的管理，指示早期出院(平均1.05天)，处方费用有限。PO低镁血症和高磷血症与PO低钙血症之间没有显着关联。最广泛使用的处理是专用碳酸钙(方案I和II)。患者在两周PO时仍有5％的轻度症状，在此期间有93％的患者停止口服治疗。
结论：测量PTH作为低钙血症预测因子的方案各不相同。每个中心都必须了解并建立其管理协议。有了这个经验,我们证明了基于钙的管理方案的有效性和安全性，PTH（正常，低,或不可检测)，和症状，所有患者都有预防性治疗的指征，而且门诊安全，费用低于长期住院。
