甲状旁腺功能减退症的并发症和症状仍未完全明确。甲状腺全切除术后早期测量血清甲状旁腺激素(PTH)和钙水平可以预测慢性甲状旁腺功能减退症的发展。该研究旨在(i)确定与慢性甲状旁腺功能减退症相关的症状和并发症,并确定这些症状和并发症的患病率(第一部分)。和(ii)检查PTH和钙的早期术后测量在预测慢性甲状旁腺功能减退中的实用性(第二部分)。我们搜查了Medline,Medline正在进行中,EMBASE,和CochraneCENTRAL以确定与慢性甲状旁腺功能减退症相关的并发症和症状。我们使用了两个预先定义的标准(至少有3项研究报告了并发症和症状,并且具有统计学上明显更大的汇总相对估计值)。为了估计患病率,我们使用报告并发症和症状的研究的中位数和四分位数间距(IQR).为了测试PTH和钙的术后早期测量值的预测值,我们使用双变量模型进行诊断检验荟萃分析.在第一部分,93项符合条件的研究共纳入18,973例患者,并报告了170例并发症和症状.我们确定了九种最常见的并发症或症状,可能与慢性甲状旁腺功能减退症有关。并发症或症状和患病率如下:肾钙化病/肾结石症(所有研究中的中位患病率为15%),肾功能不全(12%),白内障(17%),缉获量(11%),心律失常(7%),缺血性心脏病(7%),抑郁症(9%),感染(11%),全因死亡率(6%)。在第二部分,有4325名患者的18项研究证明合格。对于PTH测量,关于后测概率,手术后12-24小时超过10pg/mL的PTH值实际上排除了慢性甲状旁腺功能减退症,而与预测概率(100%)无关。当PTH值低于10pg/mL时,后测概率从3%到64%不等。九种并发症和症状可能与慢性甲状旁腺功能减退症有关。在全甲状腺切除术后12-24小时,PTH值高于阈值10pg/mL是患者不会发展慢性甲状旁腺功能减退症的强预测因子。PTH值低于阈值的患者需要仔细监测,因为有些患者会发展为慢性甲状旁腺功能减退症。©2022美国骨与矿物研究协会(ASBMR)。
The complications and symptoms of hypoparathyroidism remain incompletely defined. Measuring serum parathyroid hormone (PTH) and calcium levels early after total thyroidectomy may predict the development of chronic hypoparathyroidism. The study aimed (i) to identify symptoms and complications associated with chronic hypoparathyroidism and determine the prevalence of those symptoms and complications (Part I), and (ii) to examine the utility of early postoperative measurements of PTH and calcium in predicting chronic hypoparathyroidism (Part II). We searched Medline, Medline In-Process, EMBASE, and Cochrane CENTRAL to identify complications and symptoms associated with chronic hypoparathyroidism. We used two predefined criteria (at least three studies reported the complication and symptom and had statistically significantly greater pooled relative estimates). To estimate prevalence, we used the median and interquartile range (IQR) of the studies reporting complications and symptoms. For testing the predictive values of early postoperative measurements of PTH and calcium, we used a bivariate model to perform diagnostic test meta-analysis. In Part I, the 93 eligible studies enrolled a total of 18,973 patients and reported on 170 complications and symptoms. We identified nine most common complications or symptoms probably associated with chronic hypoparathyroidism. The complications or symptoms and the prevalence are as follows: nephrocalcinosis/nephrolithiasis (median prevalence among all studies 15%), renal insufficiency (12%), cataract (17%), seizures (11%), arrhythmia (7%), ischemic heart disease (7%), depression (9%), infection (11%), and all-cause mortality (6%). In Part II, 18 studies with 4325 patients proved eligible. For PTH measurement, regarding the posttest probability, PTH values above 10 pg/mL 12-24 hours postsurgery virtually exclude chronic hypoparathyroidism irrespective of pretest probability (100%). When PTH values are below 10 pg/mL, posttest probabilities range from 3% to 64%. Nine complications and symptoms are probably associated with chronic hypoparathyroidism. A PTH value above a threshold of 10 pg/mL 12-24 hours after total thyroidectomy is a strong predictor that the patients will not develop chronic hypoparathyroidism. Patients with PTH values below the threshold need careful monitoring as some will develop chronic hypoparathyroidism. © 2022 American Society for Bone and Mineral Research (ASBMR).