부갑상선 호르몬 측정을 이용한 갑상선 전절제술 후저칼슘혈증의 조기 예측|RISS 상세보기

다국어 초록 (Multilingual Abstract)

Background and Objectives：Parathyroid dysfunction following a total or completion thyroidectomy is not uncommon and it may be associated with significant patient morbidity. If there is a simple test with proven high predictability for identifying which patients will develop hypocalcemia, it would be very useful to determine the necessities of careful monitoring and calcium replacement. The purpose of this study is to determine which test would be the most valuable predictor of post-thyroidectomy hypocalcemia. Subjects and Method：Prospective series of 63 consecutive patients undergoing total or completion thyroidectomy were enrolled for this study. Calcium and ionized calcium were measured before and immediately after surgery, and daily during hospitalization. Parathyroid hormone (PTH) was measured immediately after surgery and early in the morning of the next day. Slopes of serum calcium, ionized calcium and PTH level change were calculated. Sensitivity, specificity and predictive values of each test for the symptomatic and biochemical hypocalcemia were compared. Results：With the cut-off value of 10 pg/ml of spot PTH, sensitivity, specificity, positive and negative predictive values of hypocalcemia were 97%, 64%, 77% and 95% respectively. By combining the spot PTH and the slope of ionized calcium change, the above values became 94%, 82%,87% and 92%. Conclusion：Immediate postoperative spot PTH level was the most valuable single test for predicting postthyroidectomy hypocalcemia. Combination of a spot PTH and the slope of ionized calcium change resulted in improved specificity and positive predictability. (Korean J Otolaryngol 2006;49:717-22)

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참고문헌 (Reference)

1 "Same-day thyroid surgery: An analysis of safety,cost savings, and outcome" 63 : 586-589, 1997

2 "Safety of thyroidectomy in residency:A review of 186 consecutive cases" 105 : 1173-1175, 1995

3 "Risk factors for postthyroidectomyhypocalcemia" 195 : 456-461, 2002

4 "Postoperative considerations: Postoperative complications" Saunders 436-439, 2003

5 "Postoperative changeof ionized calcium level after total thyroidectomy and risk factors ofpostoperative permanent hypoparathyroidism" 47 : 1159-1163, 2004

6 "Oral calcium supplements to enhance early hospitaldischarge after bilateral surgical treatment of the thyroid gland orexploration of the parathyroid glands" 178 : 11-6, 1994

7 "Metabolic complication of thyroid surgery: Hypocalcemiaand hypoparathyroidism; Hypocalcetonemia; and Hypothyroidism andhyperthyroidism" Lippincott-Raven 717-738, 1997

8 "Medical complications of thyroid surgery" 13 : 99-107, 1980

9 "Measurement of early serumcalcium levels in predicting hypocalcemia after total/near-total thyroidectomy" 44 : 1183-1186, 2001

10 "Intraoperative parathyroid hormone assay: An accurate predictor ofsymptomatic hypocalcemia following thyroidectomy" 138 : 632-635, 2003