DataSheet_1_Postoperative hypoparathyroidism after thyroid operation and exploration of permanent hypoparathyroidism evaluation.xlsx

BackgroundTo investigate the risk factors for hypoparathyroidism, discuss the prevention of postoperative hypoparathyroidism, and explore permanent postoperative hypoparathyroidism evaluation (PPHE).
MethodsA total of 2,903 patients with thyroid nodules were treated between October 2012 and August 2015. Serum calcium and intact parathyroid hormone (iPTH) levels were measured at 1 day, 1 month, and 6 months postoperatively. The incidence and management of hypoparathyroidism were analyzed. The PPHE was established based on the risk factors and clinical practice.
ResultsA total of 637 (21.94%) patients developed hypoparathyroidism, and 92.15% of them had malignant nodules. The incidence rates of transient and permanent hypoparathyroidism were 11.47% and 10.47%, respectively. The iPTH level was lower in patients with malignant nodules who underwent total thyroidectomy (TT) and central-compartment neck dissection (CND). These factors were independently associated with the recovery rate of parathyroid function. The formula for PPHE is as follows: {iPTH} + {sCa} + {surgical procedure} + {reoperation} + {pathologic type}. A scoring system was developed, and we scored low, middle, and high risk of permanent postoperative hypoparathyroidism as 4–6, 7–9, and 10–13, respectively. The differences in the recovery rates of parathyroid function in several risk groups were statistically significant (p < 0.001).
ConclusionSimultaneous TT and CND is a risk factor for hypoparathyroidism. The reoperation is not associated with hypoparathyroidism. Identification of parathyroid glands in situ and preservation of their vascular pedicles are key factors in managing hypoparathyroidism. PPHE can forecast the risk of permanent postoperative hypoparathyroidism well.

背景：本研究旨在探讨甲状旁腺功能减退症的危险因素，探讨术后甲状旁腺功能减退症的预防策略，并探索术后永久性甲状旁腺功能减退症评估（permanent postoperative hypoparathyroidism evaluation, PPHE）。方法：本研究纳入2012年10月至2015年8月期间接受治疗的2903例甲状腺结节患者，分别于术后1天、1个月及6个月检测血清钙与完整甲状旁腺激素（intact parathyroid hormone, iPTH）水平，分析甲状旁腺功能减退症的发生率与临床管理方案，并基于危险因素及临床实践建立PPHE评估模型。结果：共计637例（21.94%）患者发生甲状旁腺功能减退症，其中92.15%的患者结节为恶性。一过性与永久性甲状旁腺功能减退症的发生率分别为11.47%与10.47%。接受甲状腺全切术（total thyroidectomy, TT）联合中央区颈淋巴结清扫术（central-compartment neck dissection, CND）的恶性结节患者，其iPTH水平更低；上述因素均与甲状旁腺功能恢复率独立相关。本研究构建的PPHE评估公式如下：{iPTH} + {sCa} + {手术方式} + {再手术史} + {病理类型}。随后建立评分系统，将术后永久性甲状旁腺功能减退症的低、中、高风险分别划分为4~6分、7~9分及10~13分。不同风险组患者的甲状旁腺功能恢复率差异具有统计学意义（p < 0.001）。结论：甲状腺全切术联合中央区颈淋巴结清扫术是甲状旁腺功能减退症的危险因素；再手术史与甲状旁腺功能减退症无显著关联。术中识别原位甲状旁腺并保留其血管蒂是防治甲状旁腺功能减退症的关键。PPHE可较好地预测术后永久性甲状旁腺功能减退症的发生风险。