目的:评估全甲状腺切除术后磷酸盐和钙/磷酸盐比值(Ca/P)作为甲状旁腺激素(PTH)替代的效用。
方法:回顾性队列研究。
方法:三级医院。
方法:我们回顾性分析了从2015年到2021年由一名外科医生在三级医院接受甲状腺全切除术的18岁或以上的患者。数据不完整的患者,先前存在的甲状旁腺功能减退症,维生素D缺乏,或肾衰竭被排除。所有患者在手术后4小时内均有PTH和血清钙,白蛋白,和术后第1天的磷酸盐水平。校正的钙用于计算Ca/P。产生受试者工作特征(ROC)曲线以比较磷酸盐水平或Ca/P与PTH。相对于小于5、10、15和20μg/mL的PTH截止值评估每个可能的替代。良好的筛选试验定义为曲线下面积(AUC)大于0.8。
结果:共有185例患者接受了甲状腺全切除术,其中有1名经过专家培训的耳鼻喉科医师。大多数患者是女性(62%)。中位年龄48岁。大多数手术是针对癌症进行的(68%)。6例(3.2%)患者需要静脉补钙,2例(1.1%)患者需要再入院治疗症状性低钙血症。在所列截止点比较磷酸盐和Ca/P与PTH的ROC曲线显示AUC范围分别为0.55至0.66和0.61至0.79。没有人达到良好筛查测试的阈值。
结论:术后磷酸盐和Ca/P比值不能替代甲状腺全切除术后的PTH水平。需要更多的研究来确定接受全甲状腺切除术的患者术后钙监测的成本效益策略。
方法:回顾性队列研究。
OBJECTIVE: Evaluate utility of postoperative phosphate and calcium/phosphate ratio (Ca/P) as surrogates for parathyroid hormone (PTH) following total thyroidectomy.
METHODS: Retrospective cohort study.
METHODS: Tertiary care hospital.
METHODS: We retrospectively reviewed patients 18 years or older who underwent total thyroidectomy in a tertiary care hospital by a single surgeon from 2015 through 2021. Patients with incomplete data, pre-existing hypoparathyroidism, vitamin D deficiency, or renal failure were excluded. All patients had PTH drawn within 4 hours of surgery and serum calcium, albumin, and phosphate levels on postoperative Day 1. Corrected calcium was used to calculate a Ca/P. Receiver operating characteristic (ROC) curves were generated to compare phosphate level or Ca/P with PTH. Each possible surrogate was assessed relative to PTH cutoffs of less than 5, 10, 15, and 20 pg/mL. A good screening test was defined as having an area under the curve (AUC) greater than 0.8.
RESULTS: A total of 185 patients underwent total thyroidectomy with 1 fellowship-trained otolaryngologist. Most patients were female (62%), median age 48 years. Most surgeries were performed for cancer (68%). Six (3.2%) patients required IV calcium supplementation and 2 (1.1%) required readmission for symptomatic hypocalcemia. ROC curves comparing phosphate and Ca/P to PTH at the listed cutoffs demonstrated AUC ranging from 0.55 to 0.66 and 0.61 to 0.79, respectively. None met the threshold for a good screening test.
CONCLUSIONS: Postoperative phosphate and Ca/P ratio are not surrogates for PTH levels following total thyroidectomy. More research is needed to identify cost-effective strategies for postoperative calcium monitoring in patients undergoing total thyroidectomy.
METHODS: Retrospective cohort study.