ObjectiveTo summarize the variation of parathyroid hormone (PTH) after thyroidectomy and the influence factors of postthyroidectomy hypocalcemia (PHC). MethodsClinical data of 95 patients who underwent thyroidectomy in Affiliated Shengjing Hospital of China Medical University from Jan. 2015 to Dec. 2015 were analyzed retrospectively. ResultsOf the 95 patients, there were 27 patient (28.42%) suffered from PHC (PHC group), and levels of serum calcium in the other 68 patients (71.58%) were normal (normal group). There was no significant difference in levels of serum calcium and PTH between the PHC group and normal group before operation (P > 0.05), but levels of serum calcium and PTH in PHC group were both lower than corresponding index of normal group after operation (P < 0.05). The levels of serum calcium and PTH both decreased in PHC group after operation (P < 0.05), and only PTH level decreased in normal group after operation (P < 0.05). PHC was related with type of operation, who underwent two-side operation had higher risk of PHC (P < 0.05), but there was no significant relationship between PHC and gender or age (P > 0.05). ConclusionsPTH is an important factor for PHC. In addition, it is easier to occur PHC when the operative range become bigger.
ObjectiveTo explore therapeutic efficacy of parathyroidectomy (PTX) in treatment of secondary hyperparathyroidism (SHPT) in patients with end-stage renal disease.MethodsThe clinical data of 50 patients who underwent PTX for uremic SHPT from January 2016 to March 2018 were collected retrospectively. The changes of serum calcium, phosphorus, and intact parathyroid hormone (iPTH) before the surgery and 1 d, 7 d, 1 month, 3 months and 12 months after the surgery were analyzed. In addition, the improvement of clinical symptoms together with the postoperative recurrence and complications were observed.ResultsTen patients underwent the subtotal PTX (SPTX), 5 cases underwent the total PTX (TPTX), and 35 cases underwent the TPTX with autotransplantation (TPTX+AT). The PTXs were performed successfully in 47/50 (94.0%) patients. After the PTX, the bone pain and skin itching were alleviated, 3 cases had the temporary injury of recurrent laryngeal nerve and the hypoparathyroidism was found in 1 case. The levels of postoperative serum iPTH, calcemia, and phosphorus were lower than those at the preoperative level, the differences were statistically significant (P<0.050). The postoperative hypocalcemia was frequently seen in 38/50 (76.0%) patients, and it was effectively controlled by the intravenous calcium. After the follow-up for 3 months, the SHPT recurred in 5 cases (10.0%), of whom 3 cases underwent the TPTX+AT. The relapse rate in 12 months after the operation was 9.1% (2/22). There were no statistical differences among the three PTXs methods in the operation successful rate (χ2=3.351, P=0.211) and relapse rates in 3 months (χ2=1.321, P=0.753) and 12 months (χ2=1.794, P=0.411) after the operation.ConclusionsIn China, TPTX+AT is more common than SPTX and TPTX in clinical application. Operations of SPTX, TPTX, and TPTX+AT are safe and effective therapeutic methods for uremic SHPT, which can significantly improve biochemical indicators and quality of life of patients.
ObjectiveTo investigate the risk factors for hypoparathyroidism following radical surgery for patients with thyroid papillary carcinoma (PTC).MethodsA retrospective analysis was made on 192 patients with PTC who underwent radical thyroidectomy in the Department of Head Neck and Thyroid Surgery of Henan Cancer Hospital from January 2019 to January 2020. There were 52 males and 140 females with a median age of 48 years. The risk factors of hypocalcemia and hypoparathyroidism syndrome were screened by χ2 test and binary logistic regression analysis.ResultsIn 192 patients the proportion of patients with normal or hypoparathyroidism after operation were 62.5% (120/192) and 37.5% (72/192), respectively. Univariate analysis showed that complications, Hashimoto’s thyroiditis (HT), total thyroidectomy, N1a staging, Ⅵ lymph node dissection and parathyroid not planted were risk factors for postoperative hypoparathyroidism in patients with PTC. Binary logistic regression analysis showed that: ① HT, N1a staging and Ⅵ lymph node dissection were independent risk factors for postoperative hypocalcemia [without HT: OR=0.313, 95%CI (0.129, 0.760), P=0.010; N1a staging: OR=3.457, 95%CI (1.637, 7.301), P=0.001; without Ⅵ lymph node dissection: OR=0.115, 95%CI (0.041, 0.323), P<0.001]. ② HT, N1a staging, Ⅵ lymph node dissection and parathyroid not planted were independent risk factors for postoperative low parathyroid hormone [without HT: OR=0.285, 95%CI (0.117, 0.698), P=0.006; N1a staging: OR=3.747, 95%CI (1.762, 7.968), P=0.001; without Ⅵ lymph node dissection: OR=0.112, 95%CI (0.039, 0.317), P<0.010; planted parathyroid: OR=0.464, 95%CI (0.221, 0.978), P=0.043].ConclusionHT, N1a staging, Ⅵ lymph node dissection and parathyroid not planted are vital risk factors for hypoparathyroidism in patients with PTC after radical thyroidectomy.
ObjectiveTo introduce patients with long-term hypocalcemia and normal parathyroid hormone (PTH) values after total thyroidectomy, and to analyze the possible causes of this phenomenon. MethodsThe medical records of 1 010 consecutive patients with total thyroidectomy treated in the Center for Diagnosis and Treatment of Thyroid Disease, the First Affiliated Hospital of Kunming Medical University from January 2019 to December 2020 were collected. Seven patients with normal PTH and blood calcium before operation and at least 2 times of PTH with hypocalcemia detected more than 6 months after operation were followed-up to understand the symptoms of hypocalcemia, vitamin D level and calcium consumption. ResultsSeven patients with thyroid papillary carcinoma underwent total thyroidectomy without parathyroid autotransplantation, and there were 6 cases with mild deficiency or insufficient of vitamin D before operation. The follow-up time was 12–28 months, and the median follow-up time was 19 months. Seven patients developed hypocalcemia after continuous administration of calcium and calcitriol, and vitamin D levels remained mild deficiency or insufficient, PTH decreased by more than 50% in 6 patients one year after operation compared with that before operation. ConclusionsPatients with long-term normal PTH values and hypocalcemia after total thyroidectomy have obviously lower PTH levels than those before operation. The possible factors are parathyroid damage during operation and vitamin D deficiency. Such these patients should be more properly referred to as “parathyroid insufficiency”.