The clinical significance of detecting drainage fluid parathyroid hormone after thyroidectomy in forecasting parathyroid function_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DONG Liying , LI Yan , LI Siqi , ZHANG Yi , ZHAO Zhijing , LIANG Ying , MAO Ying ,  MA Junfeng

Department of Thyroid-Breast Surgery, The Second Afiliated Hospital of Kunming Medical University, Kunming 650031, P. R. China;

Corresponding author：

MA Junfeng, Email: myyjf88@163.com

Keywords：

thyroidectomy; drainage fluid parathyroid hormone; serum intact parathyroid hormone; serum calcium

DOI：

10.7507/1007-9424.201903083

Video：

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Objective To explore the clinical significance of detecting serum intact parathyroid hormone (iPTH) and drainage fluid parathyroid hormone (dPTH) after thyroidectomy in forecasting parathyroid function.Methods The clinical data of 95 thyroidectomy patients in the same treatment group from March 2018 to September 2018 were retrospectively analyzed, which in the Department of Thyroid-Breast Surgery, the Second Affiliated Hospital of Kunming Medical University. According to the surgical method, the patients were divided into 3 groups: isthmus and unilateral thyroidectomy (partial resection group, n=33), total thyroidectomy (total resection group, n=33) and total thyroidectomy and central lymph node excision (radical resection group, n=29). The negative pressure drainage tube was placed in the operative area. The iPTH and serum calcium were detected before and the first day after operation. The dPTH was detected in the first day and the second day after operation. Serum calcium, iPTH and dPTH were statistically analyzed.Results There were no significant differences in operative time, hospital stay and blood loss between the total resection group and the radical resection group (P>0.05), but the partial resection group were all less than the other two groups (P<0.01). On the first day after operation, the iPTH in the three groups were lower than that before operation, and the iPTH was significantly decreased in the total resection group and the radical resection group, with statistically significant difference (P<0.05). The dPTH in the three groups were significantly increased on the first and second day after operation (P<0.05), but there was no statistically significant difference between the three groups (P>0.05). There was no statistically significant difference in serum calcium between the three groups on the first day after operation (P>0.05).Conclusions The levels of iPTH, dPTH and serum calcium after thyroidectomy can comprehensively forecast the parathyroid function. Preventive calcium supplementation can reduce the occurrence of postoperative symptomatic hypocalcemia, which is conducive to the recovery of parathyroid function.

Citation： DONG Liying, LI Yan, LI Siqi, ZHANG Yi, ZHAO Zhijing, LIANG Ying, MAO Ying, MA Junfeng. The clinical significance of detecting drainage fluid parathyroid hormone after thyroidectomy in forecasting parathyroid function. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(10): 1196-1200. doi: 10.7507/1007-9424.201903083 Copy

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2.	孙嘉伟, 许晓君, 蔡秋茂, 等. 中国甲状腺癌发病趋势分析. 中国肿瘤, 2013, 22(9): 690-693.
3.	中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 2015, 35(7): 731-736.
4.	程若川, 艾杨卿, 刁畅. 甲状腺手术中甲状旁腺显露及功能保护的临床研究. 中国普外基础与临床杂志, 2009, 16(5): 351-355.
5.	闫利英, 赵瑞敏, 施秉银. 甲状腺术中快速甲状旁腺素测定对预测术后低钙血症发生危险性的研究进展. 中华耳鼻喉头颈外科杂志, 2006, 46(6): 474-476.
6.	周广起, 刘新梅, 熊斌, 等. 分化型甲状腺癌术后PTH 变化及发生低钙血症的临床分析. 中国普通外科杂志, 2014, 23(5): 700-702.
7.	Del Rio P, Arcuri MF, Ferreri G, et al. The utility of serum PTH assessment 24 hours after total thyroidectomy. Otolaryngol Head Neck Surg, 2005, 132(4): 584-586.
8.	Khairy GA, Al-Saif A. Incidental parathyroidectomy during thyroid resection: incidence,risk factors, and outcome. AnnSaudi Med, 2011, 31(3): 274-278.
9.	Kim JP, Park JJ, Son HY, et al. Effectiveness of an i-PTH measurement in predicting post thyroidectomy hypocalcemia: prospective controlled study. Yonsei Med J, 2013, 54(3): 637-642.
10.	姚京, 田文. 甲状腺全切除术后血清和术区引流液全段甲状旁腺激素检测的临床意义. 中国普外基础与临床杂志, 2014, 21(11): 1413-1416.
11.	Gopalakrishna Iyer N, Shaha AR. Complications of thyroid surgery: prevention and management. Minerva Chir, 2010, 65(1): 71-82.
12.	Park I, Rhu J, Woo JW, et al. Preserving parathyroid gland vasculature to reduce post-thyroidectomy hypocalcemia. World J Surg, 2016, 40(6): 1382-1389.
13.	中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺围手术期甲状旁腺功能保护指南(2018 版). 中国实用外科杂志, 2018, 38(10): 1108-1113.
14.	Cho JN, Park WS, Min SY. Predictors and risk factors of hypoparathyroidism after total thyroidectomy. Int J Surg, 2016, 34: 47-52.
15.	Wei T, Li Z, Jin J, et al. Autotransplantation of inferior parathyroid glands during central neck dissection for papillary thyroid carcinoma: a retrospective cohort study. Int J Surg, 2014, 12(12): 1286-1290.
16.	王平, 王勇, 曹利平. 甲状旁腺自体移植手术方式与功能判断. 中国实用外科杂志, 2012, 32(5): 420-422.
17.	Nemade SV, Chirmade AP. Post-thyroidectomy early serum ionic calcium level: predictor of prolonged hypocalcemia. Ear Nose Throat J, 2013, 92(8): 382-390.
18.	Singer MC, Bhakta D, Seybt MW, et al. Calcium management after thyroidectomy: a simple and cost-effective method. Otolaryngol Head Neck Surg, 2012, 146(3): 362-365.
19.	Stack BC, Bimston DN, Bodenner DL, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Reviews: postoperative hypoparathyroidism definitions and management. Endocr Pract, 2015, 21(6): 674-685.
20.	中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 甲状腺外科能量器械应用专家共识(2017 版). 中国实用外科杂志, 2017, 37(9): 992-997.

1. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, et al. Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 2009, 19(11): 1167-1214.
2. 孙嘉伟, 许晓君, 蔡秋茂, 等. 中国甲状腺癌发病趋势分析. 中国肿瘤, 2013, 22(9): 690-693.
3. 中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 2015, 35(7): 731-736.
4. 程若川, 艾杨卿, 刁畅. 甲状腺手术中甲状旁腺显露及功能保护的临床研究. 中国普外基础与临床杂志, 2009, 16(5): 351-355.
5. 闫利英, 赵瑞敏, 施秉银. 甲状腺术中快速甲状旁腺素测定对预测术后低钙血症发生危险性的研究进展. 中华耳鼻喉头颈外科杂志, 2006, 46(6): 474-476.
6. 周广起, 刘新梅, 熊斌, 等. 分化型甲状腺癌术后PTH 变化及发生低钙血症的临床分析. 中国普通外科杂志, 2014, 23(5): 700-702.
7. Del Rio P, Arcuri MF, Ferreri G, et al. The utility of serum PTH assessment 24 hours after total thyroidectomy. Otolaryngol Head Neck Surg, 2005, 132(4): 584-586.
8. Khairy GA, Al-Saif A. Incidental parathyroidectomy during thyroid resection: incidence,risk factors, and outcome. AnnSaudi Med, 2011, 31(3): 274-278.
9. Kim JP, Park JJ, Son HY, et al. Effectiveness of an i-PTH measurement in predicting post thyroidectomy hypocalcemia: prospective controlled study. Yonsei Med J, 2013, 54(3): 637-642.
10. 姚京, 田文. 甲状腺全切除术后血清和术区引流液全段甲状旁腺激素检测的临床意义. 中国普外基础与临床杂志, 2014, 21(11): 1413-1416.
11. Gopalakrishna Iyer N, Shaha AR. Complications of thyroid surgery: prevention and management. Minerva Chir, 2010, 65(1): 71-82.
12. Park I, Rhu J, Woo JW, et al. Preserving parathyroid gland vasculature to reduce post-thyroidectomy hypocalcemia. World J Surg, 2016, 40(6): 1382-1389.
13. 中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺围手术期甲状旁腺功能保护指南(2018 版). 中国实用外科杂志, 2018, 38(10): 1108-1113.
14. Cho JN, Park WS, Min SY. Predictors and risk factors of hypoparathyroidism after total thyroidectomy. Int J Surg, 2016, 34: 47-52.
15. Wei T, Li Z, Jin J, et al. Autotransplantation of inferior parathyroid glands during central neck dissection for papillary thyroid carcinoma: a retrospective cohort study. Int J Surg, 2014, 12(12): 1286-1290.
16. 王平, 王勇, 曹利平. 甲状旁腺自体移植手术方式与功能判断. 中国实用外科杂志, 2012, 32(5): 420-422.
17. Nemade SV, Chirmade AP. Post-thyroidectomy early serum ionic calcium level: predictor of prolonged hypocalcemia. Ear Nose Throat J, 2013, 92(8): 382-390.
18. Singer MC, Bhakta D, Seybt MW, et al. Calcium management after thyroidectomy: a simple and cost-effective method. Otolaryngol Head Neck Surg, 2012, 146(3): 362-365.
19. Stack BC, Bimston DN, Bodenner DL, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Reviews: postoperative hypoparathyroidism definitions and management. Endocr Pract, 2015, 21(6): 674-685.
20. 中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 甲状腺外科能量器械应用专家共识(2017 版). 中国实用外科杂志, 2017, 37(9): 992-997.

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The clinical significance of detecting drainage fluid parathyroid hormone after thyroidectomy in forecasting parathyroid function

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